Provider Demographics
NPI:1417505603
Name:BRANCH, TIFFANI (BCBA)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:BRANCH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 LONGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1325
Mailing Address - Country:US
Mailing Address - Phone:973-763-1804
Mailing Address - Fax:
Practice Address - Street 1:578 LONGVIEW RD
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1325
Practice Address - Country:US
Practice Address - Phone:973-763-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-36097103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst