Kathleen Louise Broad | West Haven, CT • PECOS Search

Kathleen Louise Broad

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

950 Campbell Ave, Room 151d, West Haven, CT 06516-2770

PECOS Enrollment

Based on the most recent information from CMS, provider Kathleen Louise Broad does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1013368240
Provider Type
Individual
Full Name
Broad, Kathleen Louise
Title
Dr.
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
6/29/2016
Last Updated
6/29/2016

Contact Information

Practice Location

950 Campbell Ave, Room 151d, West Haven, CT 06516-2770

Unlisted Fax

Mailing Location

950 Campbell Ave, Room 151d, West Haven, CT 06516-2770

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2084P0800X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License 055144 Connecticut