Provider Demographics
NPI:1780126557
Name:CAROLYN BRANSON PLLC
Entity type:Organization
Organization Name:CAROLYN BRANSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-232-4490
Mailing Address - Street 1:7 TIDEWATER CV
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2110
Mailing Address - Country:US
Mailing Address - Phone:207-232-4490
Mailing Address - Fax:207-283-0038
Practice Address - Street 1:222 AUBURN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6002
Practice Address - Country:US
Practice Address - Phone:207-232-4490
Practice Address - Fax:207-283-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty