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General NPI Number Information
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NPI Number | 1003411596
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Entity Type | Individual
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Provider Name | CAROLINE BRANNOCK BCBA
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Gender | Female
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 10 6TH AVE W
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City | HUNTINGTON
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State | WV
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Zip | 25701-0028
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Country | US
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Telephone | 304-525-8014
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Fax | 304-525-8026
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Provider Business Mailing Address
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Address Line | 3209 CHASE ST
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City | HUNTINGTON
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State | WV
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Zip | 25704-2014
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Country | US
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Telephone | 410-603-7298
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | COBA.01573
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-22-61579
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License Number State | WV
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