Provider Demographics
NPI:1518270917
Name:BRACH, PESSY Y (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PESSY
Middle Name:Y
Last Name:BRACH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 16TH AVE
Mailing Address - Street 2:2H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1818
Mailing Address - Country:US
Mailing Address - Phone:718-438-2449
Mailing Address - Fax:
Practice Address - Street 1:5507 16TH AVE
Practice Address - Street 2:2H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1818
Practice Address - Country:US
Practice Address - Phone:718-438-2449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 019228235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist