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

Prof. Staci Broadwell, PSYD

Individual provider Clinical Psychologist · NPI 1467696419

Prof. Staci Broadwell, PSYD is a Clinical Psychologist in Phoenix, Arizona. Qualified in 2005, 21 years ago. Practices with Banner Physician Specialists Arizona LLC, a 372-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Arizona and New York.

Years since qualifying
21
Licensed in
AZ, NY
In the registry since
2009
Specialties on file
2
What do these letters mean?
PSYD — Doctor of Psychology
A doctoral psychologist trained primarily for clinical practice.

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Practice location Address checks out

3830 E Van Buren St
Phoenix, AZ 85008-6920
Phone: (602) 243-7277
Fax: (602) 286-0808
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 4519 (AZ)
Clinical Psychologist Taxonomy 103TC0700X · Licence 017898 (NY)

Record details

NPI number1467696419
Entity typeIndividual (Type 1)
GenderFemale
Credentials PSYD
Sole proprietorNo
NPI enumeratedApril 21, 2009
Last updated in NPPESJune 12, 2024

Medicare enrollment

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

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Banner Physician Specialists Arizona Llc — 372 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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