Provider Demographics
NPI:1972135739
Name:BRANCH, ELIZABETH CAROLINE (MA,BCBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CAROLINE
Last Name:BRANCH
Suffix:
Gender:F
Credentials:MA,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18940 HUNTER DR
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-4218
Mailing Address - Country:US
Mailing Address - Phone:985-974-9236
Mailing Address - Fax:
Practice Address - Street 1:800 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5328
Practice Address - Country:US
Practice Address - Phone:985-231-7612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst