EDEN BROBERG MA - NPI 1265190474 - Counselor in Stillwater, MN

Q: What is Eden Broberg's NPI number?

The NPI number for Eden Broberg is 1265190474. It was assigned to this individual provider in the NPPES registry on December 5, 2021.

Q: What is Eden Broberg's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Eden Broberg was last updated on May 11, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Eden Broberg Ma NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDEN BROBERG MA (NPI 1265190474) is an individual mental health provider in Stillwater, Minnesota and active in the NPI registry since December 2021. She is enrolled in Medicare PECOS and maintains a secondary practice location in Minneapolis.

NPPES Registry Identity

NPI1265190474

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameEDEN BROBERGCredential: MA

Location Address6381 OSGOOD AVE N BLDG CStillwater, MN 55082-6118

Mailing Address6381 Osgood Ave N Bldg CStillwater, MN 55082-6118 · (651) 401-8162 · Fax (651) 383-4544

Phone(651) 401-8162

Fax(651) 383-4544

Sole ProprietorYes

Enumeration DateDecember 5, 2021

Last NPPES UpdateMay 11, 20232 updates tracked since enumeration

NPPES CertifiedMay 11, 2023

✔ NPI 1265190474 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

6381 OSGOOD AVE N BLDG C, Stillwater, MN 55082

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Secondary Practice Location 1

Location 15354 Parkdale Dr Fl 2Minneapolis, MN 55416-1603 · Phone (651) 645-5323 ext. 1449

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Eden Broberg Ma is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.