Organization
DARRELL BROADDUS PSYCHOLOGICAL SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRELL BROADDUS (OWNER/OPERATOR)
(916) 412-4270
Entity
Organization
Contact information
Practice address
6128 VIA PRESIDIO, ORANGEVALE, CA 95662-4460
(916) 412-4270
Mailing address
PO BOX 750834, FOREST HILLS, NY 11375-0834
(718) 268-6600
(718) 268-6065
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY 20101
CALIFORNIA LICENSE
CA
Enumeration date
09/17/2014
Last updated
09/17/2014
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