Provider Demographics
NPI:1043780737
Name:BRANCO, TORI LYNNE
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:LYNNE
Last Name:BRANCO
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 1:1514 LINCOLN BLVD APT 7
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2916
Mailing Address - Country:US
Mailing Address - Phone:209-407-7138
Mailing Address - Fax:
Practice Address - Street 1:1514 LINCOLN BLVD APT 7
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2916
Practice Address - Country:US
Practice Address - Phone:209-407-7138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst