Provider Demographics
NPI:1700924412
Name:BRANCH, CAMILLE N
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:N
Last Name:BRANCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PUTNAM ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4729
Mailing Address - Country:US
Mailing Address - Phone:925-978-2979
Mailing Address - Fax:
Practice Address - Street 1:2 EDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-1841
Practice Address - Country:US
Practice Address - Phone:650-994-7110
Practice Address - Fax:650-994-7180
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor