Healthcare Provider Details

I. General information

NPI: 1235068669
Provider Name (Legal Business Name): ROBIANN BROOMFIELD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 1ST AVE # 2112
PHOENIX AZ
85003-1401
US

IV. Provider business mailing address

802 N 1ST AVE UNIT 2112
PHOENIX AZ
85003-1843
US

V. Phone/Fax

Practice location:
  • Phone: 417-761-9133
  • Fax:
Mailing address:
  • Phone: 417-761-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-006133
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10001888
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: