Provider Demographics
NPI:1710268883
Name:BRANCH, RONALD D
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:BRANCH
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 1:408 N CANYON ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5812
Mailing Address - Country:US
Mailing Address - Phone:575-234-3305
Mailing Address - Fax:575-725-5999
Practice Address - Street 1:700 W STEVENS ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4958
Practice Address - Country:US
Practice Address - Phone:575-234-3305
Practice Address - Fax:575-725-5999
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NMM-086751041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator