Provider Demographics
NPI:1881992857
Name:BROADHURST, KACEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:KACEY
Middle Name:
Last Name:BROADHURST
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3233
Mailing Address - Country:US
Mailing Address - Phone:603-620-6824
Mailing Address - Fax:603-673-8742
Practice Address - Street 1:20 LIBRARY ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-4240
Practice Address - Country:US
Practice Address - Phone:603-881-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH93285103TS0200X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling