DOMINIQUE VICTORIA BROADNAX PSYD
NPI 1679205074
Psychologist - Clinical in Boston, MA

Q: What is Dominique Broadnax's NPI number?

The NPI number for Dominique Broadnax is 1679205074. It was assigned to this individual provider in the NPPES registry on June 26, 2022.

Q: What is Dominique Broadnax's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Active since June 26, 2022PECOS EnrolledAccepts Medicare Assignment

75 FENWOOD RD, BOSTON, MA 02115(617) 626-9300 Get Directions Write a Review

NPPES record last updated: October 21, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dominique Victoria Broadnax Psyd NPPES

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

DOMINIQUE VICTORIA BROADNAX PSYD (NPI 1679205074) is an individual clinical provider in Boston, Massachusetts, licensed in Massachusetts (PSY10001846) and active in the NPI registry since June 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1679205074

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameDOMINIQUE VICTORIA BROADNAXCredential: PSYD

Location Address75 FENWOOD RDBoston, MA 02115-6103

Mailing Address75 Fenwood RdBoston, MA 02115-6103

Phone(617) 626-9300

Sole ProprietorNo

Medical School CMSOtherGraduated 2024

Enumeration DateJune 26, 2022

Last NPPES UpdateOctober 21, 2025

NPPES CertifiedOctober 21, 2025

✔ NPI 1679205074 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Licenses✔ Licensed in MA · PSY10001846✔ Licensed in RI · PS02359

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

75 FENWOOD RD, Boston, MA 02115

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dominique Victoria Broadnax Psyd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6204323876

PECOS Enrollment IDI20251016002048

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02115 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$189.86 typical visit price

range $63.72 – $189.86

Typical copayment $47.46 (range $15.93 – $47.46)

Most-billed visit code 99205

Established Patient

$111.18 typical visit price

range $21.07 – $155.29

Typical copayment $27.79 (range $5.26 – $38.82)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MATTIGAN MORAN LCSW

Social Worker

75 FENWOOD RD
BOSTON, MA 02115

Suffolk County (617) 626-9479

DR. DANIEL EDWARDS PSYD

Psychologist (Clinical)

75 FENWOOD RD
BOSTON, MA 02115

Suffolk County (617) 626-9318

MS. KATHLEEN MARIE PUCKETT-LESLIE APRN,BC

Registered Nurse (Psychiatric/Mental Health)

75 FENWOOD RD
BOSTON, MA 02115

Suffolk County (617) 626-9300

THE COMMONWEALTH OF MASSACHUSETTS

Clinic/Center (Mental Health (Including Community Mental Health Center))

75 FENWOOD RD
BOSTON, MA 02115

Suffolk County (617) 626-9300

ELIZABETH MARIE TEMPLETON LCSW

Social Worker (Clinical)

75 FENWOOD RD, MASS. MENTAL HEALTH CENTER
BOSTON, MA 02115

Suffolk County (617) 626-9464

ELIZA ALDEN SORENSON LICSW

Social Worker (Clinical)

75 FENWOOD RD
BOSTON, MA 02115

Suffolk County (617) 626-9323

KAITLYN ROCHA

Counselor

75 FENWOOD RD
BOSTON, MA 02115

Suffolk County (617) 626-9793

GI YI HO

Counselor

75 FENWOOD RD
BOSTON, MA 02115

Suffolk County (617) 860-2086

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dominique Broadnax's NPI number?

The NPI number for Dominique Broadnax is 1679205074. It was assigned to this individual provider in the NPPES registry on June 26, 2022.

Where is Dominique Broadnax located?

Dominique Broadnax practices at 75 Fenwood Rd, Boston, MA 02115. The listed phone number is (617) 626-9300.

What is Dominique Broadnax's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Dominique Broadnax enrolled in Medicare?

Yes. Dominique Broadnax is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Dominique Broadnax was last updated on October 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.