Healthcare Provider Details

I. General information

NPI: 1679377360
Provider Name (Legal Business Name): HANNAH BROOMFIELD LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 ARNOLD ST
WAKEFIELD RI
02879-3701
US

IV. Provider business mailing address

25 TANGLEWOOD DR APT 5
WEST WARWICK RI
02893-2013
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-9390
  • Fax:
Mailing address:
  • Phone: 401-572-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP01020
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: