Provider Demographics
NPI:1225771371
Name:BRANCH BEHAVIORAL HEALTH SERVICE VIRTUAL PSYCHIATRY
Entity Type:Organization
Organization Name:BRANCH BEHAVIORAL HEALTH SERVICE VIRTUAL PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFRIES-BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:267-307-2077
Mailing Address - Street 1:1150 FIRST AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1316
Mailing Address - Country:US
Mailing Address - Phone:610-934-2200
Mailing Address - Fax:
Practice Address - Street 1:2212 RONALD DR
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1353
Practice Address - Country:US
Practice Address - Phone:126-730-7207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-17
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty