Provider Demographics
NPI:1629752647
Name:BRANCO, TAYLOR DANIELLE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DANIELLE
Last Name:BRANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364A BRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6058
Mailing Address - Country:US
Mailing Address - Phone:732-664-1713
Mailing Address - Fax:
Practice Address - Street 1:35 BEAVERSON BLVD STE 11
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7869
Practice Address - Country:US
Practice Address - Phone:866-557-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRBT-23-265378106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician