Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kelly Anne Broderick, LICSW

Individual provider Case Manager/Care Coordinator · NPI 1407193758

Kelly Anne Broderick, LICSW is a Clinical Social Worker in Lynn, Massachusetts. Qualified in 2017, 9 years ago. Practices as a sole proprietor. Licensed in Massachusetts.

Years since qualifying
9
Licensed in
MA
In the registry since
2013
Specialties on file
2
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

152 Lynnway Ste 2C
Lynn, MA 01902-3420
Phone: (617) 982-3996
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 122657 (MA)
Case Manager/Care Coordinator Taxonomy 171M00000X

Record details

NPI number1407193758
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorYes
NPI enumeratedJanuary 7, 2013
Last updated in NPPESMay 28, 2020
Certification dateMay 28, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Accepts Medicare assignment Not indicated

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