Provider Demographics
NPI:1558962738
Name:BRACH, SHABSE
Entity Type:Individual
Prefix:
First Name:SHABSE
Middle Name:
Last Name:BRACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DINEV RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-6487
Mailing Address - Country:US
Mailing Address - Phone:845-782-7510
Mailing Address - Fax:
Practice Address - Street 1:1 DINEV RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-6487
Practice Address - Country:US
Practice Address - Phone:845-782-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110961104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker