Healthcare Provider Details

I. General information

NPI: 1811379076
Provider Name (Legal Business Name): KATHERINE LORETTA BRANAGAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 ADAM CLAYTON POWELL JR BLVD FL 4
NEW YORK NY
10027-4941
US

IV. Provider business mailing address

2090 ADAM CLAYTON POWELL JR BLVD FL 4
NEW YORK NY
10027-4941
US

V. Phone/Fax

Practice location:
  • Phone: 212-553-6708
  • Fax:
Mailing address:
  • Phone: 212-553-6708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number096846
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088471
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: