Healthcare Provider Details

I. General information

NPI: 1003262197
Provider Name (Legal Business Name): QUANESHA BRABHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 GUADALUPE ST STE 260
AUSTIN TX
78705-5654
US

IV. Provider business mailing address

2021 GUADALUPE ST STE 260
AUSTIN TX
78705-5654
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 646-941-7645
  • Fax: 929-596-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: