Provider Demographics
NPI:1265623854
Name:BRANCU, MIRA (PHD)
Entity type:Individual
Prefix:DR
First Name:MIRA
Middle Name:
Last Name:BRANCU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:MIRA
Other - Middle Name:BRANCU
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, NCC, LPC
Mailing Address - Street 1:112 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-5574
Mailing Address - Country:US
Mailing Address - Phone:919-240-4278
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:DURHAM VAMC
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4061103TC0700X, 103T00000X, 284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No284300000XHospitalsSpecial Hospital