Healthcare Provider Details

I. General information

NPI: 1730548223
Provider Name (Legal Business Name): CURTIS BRANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 ANDERSON ST APT 1F
HACKENSACK NJ
07601-4430
US

IV. Provider business mailing address

70 ANDERSON ST APT 1F
HACKENSACK NJ
07601-4430
US

V. Phone/Fax

Practice location:
  • Phone: 551-587-1500
  • Fax: 973-622-4813
Mailing address:
  • Phone: 551-587-1500
  • Fax: 973-622-4813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4046
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CURTIS W. BRANCH
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 551-587-1500