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General NPI Number Information
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NPI Number | 1669320396
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Entity Type | Individual
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Provider Name | MS. JAZA BROADWATER
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Gender | Female
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 10 MEADOWBROOK RD
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City | BROCKTON
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State | MA
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Zip | 02301-7122
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Country | US
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Telephone | 508-580-0108
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Fax |
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Provider Business Mailing Address
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Address Line | 87 ROWE ST
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City | ROSLINDALE
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State | MA
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Zip | 02131-3715
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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