Provider Demographics
NPI:1578226221
Name:BRACH, ANNIE
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:
Last Name:BRACH
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 1:1455 59TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5017
Mailing Address - Country:US
Mailing Address - Phone:347-817-6421
Mailing Address - Fax:
Practice Address - Street 1:45 RADIANT HL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4988
Practice Address - Country:US
Practice Address - Phone:732-523-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst