Provider Demographics
NPI:1255772901
Name:BRANGOCCIO, KIMBERLY SUE (LMFT, CEAP, IAADC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:SUE
Last Name:BRANGOCCIO
Suffix:
Gender:F
Credentials:LMFT, CEAP, IAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 NE DARTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9660
Mailing Address - Country:US
Mailing Address - Phone:515-727-1338
Mailing Address - Fax:515-727-1340
Practice Address - Street 1:700 E UNIVERSITY AVE
Practice Address - Street 2:ILH 4-MID
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2302
Practice Address - Country:US
Practice Address - Phone:515-263-2442
Practice Address - Fax:515-263-2463
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00046106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist