Healthcare Provider Details

I. General information

NPI: 1588198683
Provider Name (Legal Business Name): CLAUDIA BRANCACCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 SUNLAND BLVD
SUN VALLEY CA
91352-3948
US

IV. Provider business mailing address

8140 SUNLAND BLVD
SUN VALLEY CA
91352-3948
US

V. Phone/Fax

Practice location:
  • Phone: 631-377-2477
  • Fax:
Mailing address:
  • Phone: 631-377-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: