Provider Demographics
NPI:1083224539
Name:BRACH, NORMA DARSHAN (MFT)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:DARSHAN
Last Name:BRACH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2634
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94966-2634
Mailing Address - Country:US
Mailing Address - Phone:415-992-1704
Mailing Address - Fax:
Practice Address - Street 1:112 MARION AVE
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2524
Practice Address - Country:US
Practice Address - Phone:415-992-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10831106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist