Individual
LISA MARIE BROADHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
BLANCHFIELD ARMY COMMUNITY HOSPITAL, 650 JOEL DRIVE, FORT CAMPBELL, KY 42223
(270) 798-8601
Mailing address
13173 AERO VISTA DR, EL PASO, TX 79908-3257
(915) 307-3941
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW003927
GA
Other
Enumeration date
11/19/2008
Last updated
07/02/2018
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