| Family Resource Center 0384 | |
|
2432 W, Peoria Avenue Suite 1327 Phoenix AZ 85029 | |
| (602) 866-3432 | |
| (602) 866-3764 |
| Full Name | Family Resource Center 0384 |
|---|---|
| Speciality | Psychologist |
| Location | 2432 W, Peoria Avenue, Phoenix, Arizona |
| Authorized Official Name and Position | Dennis E. Broadbent (PSYCHOLOGIST (DIRECTOR)) |
| Authorized Official Contact | 6028663432 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Resource Center 0384 2432 W, Peoria Avenue Suite 1327 Phoenix AZ 85029 Ph: (602) 866-3432 | Family Resource Center 0384 2432 W, Peoria Avenue Suite 1327 Phoenix AZ 85029 Ph: (602) 866-3432 |
| NPI Number | 1316083728 |
|---|---|
| Provider Enumeration Date | 01/30/2007 |
| Last Update Date | 06/11/2013 |
| Medicare PECOS PAC ID | 9830331347 |
|---|---|
| Medicare Enrollment ID | O20130813000692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316083728 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | LPC2693 (Arizona) | Secondary |
| 106H00000X | Marriage & Family Therapist | LMFT10254 (Arizona) | Secondary |
| 103T00000X | Psychologist | 903 (Arizona) | Primary |
| Provider Name | Dennis E Broadbent |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124209275 PECOS PAC ID: 2163457979 Enrollment ID: I20050929001326 |
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