Healthcare Provider Details

I. General information

NPI: 1881992857
Provider Name (Legal Business Name): KACEY BROADHURST PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LIBRARY ST
HUDSON NH
03051-4240
US

IV. Provider business mailing address

26 TAYLOR DR
MILFORD NH
03055-3233
US

V. Phone/Fax

Practice location:
  • Phone: 603-881-3930
  • Fax:
Mailing address:
  • Phone: 603-620-6824
  • Fax: 603-673-8742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number93285
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: