MEDICARE: MRS. KATRINA LYNN BROADBENT MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	000227301	MA
2	1041C0700X	Clinical Social Worker	LICSW257	MA

General Provider Information

NPI Number	:	1295593705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATRINA LYNN BROADBENT MSW, LCSW

Provider Business Mailing Address
First Line	:	615 BRIGHAM ST
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-3151
Country	:	US
Telephone Number	:	508-614-9068
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 MOUNT ROYAL AVE
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-1985
Country	:	US
Telephone Number	:	508-614-9068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	08/15/2024

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