Provider Demographics
NPI:1598041873
Name:BRANCH, ELLIOTT AARON JR (LSW)
Entity Type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:AARON
Last Name:BRANCH
Suffix:JR
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SCHOONMAKER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062-1007
Mailing Address - Country:US
Mailing Address - Phone:724-454-7136
Mailing Address - Fax:
Practice Address - Street 1:701 SCHOONMAKER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062-1007
Practice Address - Country:US
Practice Address - Phone:724-454-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129047104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker