Provider Demographics
NPI:1508265554
Name:BRANN, MARIANNE MEGHAN
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:MEGHAN
Last Name:BRANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:MEGHAN
Other - Last Name:O'MALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:747 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351-3528
Mailing Address - Country:US
Mailing Address - Phone:207-660-2662
Mailing Address - Fax:
Practice Address - Street 1:747 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351-3528
Practice Address - Country:US
Practice Address - Phone:207-660-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1-14-15591103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst