Individual
KATHERINE LYNN BROUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1060 NUGGETT ST, LOS ALAMOS, NM 87544-2922
(505) 412-2961
Mailing address
113 AZURE DR, WHITE ROCK, NM 87547-3506
(505) 412-9045
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SWB-2026-0086
NM
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/12/2025
Last updated
01/27/2026
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