Provider Demographics
NPI:1124580972
Name:BRANCA, MARCIA BRADLEY (MFT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:BRADLEY
Last Name:BRANCA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:JEANNE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:81-972 S KAHAPILI LOOP
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-8114
Mailing Address - Country:US
Mailing Address - Phone:415-233-1747
Mailing Address - Fax:844-766-7659
Practice Address - Street 1:81-972 S KAHAPILI LOOP
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-8114
Practice Address - Country:US
Practice Address - Phone:415-233-1747
Practice Address - Fax:844-766-7659
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT18213106H00000X
HI16718225700000X
HI645106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist