Provider Demographics
NPI:1104416379
Name:BROADBENT, BENJAMIN TAYLOR
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TAYLOR
Last Name:BROADBENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BOBCAT BLVD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NH
Mailing Address - Zip Code:03244-7419
Mailing Address - Country:US
Mailing Address - Phone:603-478-5326
Mailing Address - Fax:
Practice Address - Street 1:11 BOBCAT BLVD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NH
Practice Address - Zip Code:03244-7419
Practice Address - Country:US
Practice Address - Phone:603-478-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor