Provider Demographics
NPI:1982187787
Name:JONI C BRANHAM LICENSED CLINICAL SOCIAL WORKER INC
Entity Type:Organization
Organization Name:JONI C BRANHAM LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-715-6984
Mailing Address - Street 1:645 E ELDER ST STE B
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3084
Mailing Address - Country:US
Mailing Address - Phone:760-715-6984
Mailing Address - Fax:760-451-0369
Practice Address - Street 1:645 E ELDER ST STE B
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3084
Practice Address - Country:US
Practice Address - Phone:760-715-6984
Practice Address - Fax:760-451-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-08
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health