REBECCA BROADDUS LISW-S LICDC NPI 1588190532

NPI Information

  • NPI: 1588190532
  • Provider Name: REBECCA BROADDUS, LISW-S, LICDC
  • Classification: Social Worker - 1041C0700X
  • Specialization: Clinical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2775 STATE ROUTE 39
    SHELBY, OH
    ZIP 44875
  • Phone: (419) 747-3322

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NPI Details

Rebecca Broaddus, LISW-S, LICDC is a clinical social worker in Shelby, OH. The provider is a social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. Rebecca Broaddus, LISW-S, LICDC NPI is 1588190532. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2775 STATE ROUTE 39
SHELBY, OH
ZIP 44875-466
Phone: (419) 747-3322

The NPI 1588190532 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 5/11/2017 and was last updated on 11/21/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YA0400XCounselorAddiction (Substance Use Disorder)LICDC.162510OHIONo
2104100000XSocial WorkerS.1502432OHIONo
31041C0700XSocial WorkerClinicalI.2203547OHIOYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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