Provider Demographics
NPI:1831248897
Name:BRANCH, ANITA
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
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 1:998 CROKKED HILL ROAD
Mailing Address - Street 2:BUILDING 69
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4625
Mailing Address - Country:US
Mailing Address - Phone:631-761-4190
Mailing Address - Fax:631-761-4184
Practice Address - Street 1:998 CROOKED HILL ROAD
Practice Address - Street 2:BUILDING 69
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4625
Practice Address - Country:US
Practice Address - Phone:631-761-4180
Practice Address - Fax:631-761-4184
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management