Provider Demographics
NPI:1679750731
Name:BROUGHTON, JOHN MARCUS (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARCUS
Last Name:BROUGHTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MORNINGSIDE DR
Mailing Address - Street 2:#63
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6011
Mailing Address - Country:US
Mailing Address - Phone:212-666-9775
Mailing Address - Fax:
Practice Address - Street 1:106 MORNINGSIDE DR
Practice Address - Street 2:#63
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6011
Practice Address - Country:US
Practice Address - Phone:212-666-9775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005556103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist