MEDICARE: DR. CHARLES S. BROADFIELD PH.D

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	NAADAC CERT #013537	VA
2	106H00000X	Marriage & Family Therapist	0717000492	VA
3	101YP2500X	Professional Counselor	0701000320	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	170089	OTHER		COMPSY
2	040416	OTHER	VA	BC/BS
3	62-91986	OTHER		UNITED BEHAV HEALTH
4	212164-312164	OTHER		MDIPA
5	80176	OTHER		SENTARA OPTIMA

General Provider Information

NPI Number	:	1740215201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES S. BROADFIELD PH.D

Provider Business Mailing Address
First Line	:	5750 CHESAPEAKE BLVD
Second Line	:	STE 105
City	:	NORFOLK
State	:	VA
Zip	:	23513-5325
Country	:	US
Telephone Number	:	757-853-1409
Fax Number	:	757-853-0825

Provider Business Practice Location Address
First Line	:	5750 CHESAPEAKE BLVD
Second Line	:	STE 105
City	:	NORFOLK
State	:	VA
Zip	:	23513-5325
Country	:	US
Telephone Number	:	757-853-1409
Fax Number	:	757-853-0825

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	09/11/2025

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Directions to “ DR. CHARLES S. BROADFIELD PH.D” Practice Location

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