Healthcare Provider Details

I. General information

NPI: 1780517755
Provider Name (Legal Business Name): MICHAEL BROUGHTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 NEW YORK AVE NW BSMT
WASHINGTON DC
20005-4701
US

IV. Provider business mailing address

3620 11TH ST NW APT 1
WASHINGTON DC
20010-1485
US

V. Phone/Fax

Practice location:
  • Phone: 202-420-9707
  • Fax:
Mailing address:
  • Phone: 914-462-9024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLC200004121
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: