Provider Demographics
NPI:1942782271
Name:BROADHURST, ELLEN M (LICSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:BROADHURST
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2797
Mailing Address - Country:US
Mailing Address - Phone:413-263-3290
Mailing Address - Fax:413-263-3278
Practice Address - Street 1:26 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2797
Practice Address - Country:US
Practice Address - Phone:413-263-3290
Practice Address - Fax:413-263-3278
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA335678101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool