=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063386811
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRANCHES INTEGRATIVE WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2025
-----------------------------------------------------
Last Update Date | 10/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 419 MAIN ST STE 7
-----------------------------------------------------
City | STURBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01566-1160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-313-9263
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 419 MAIN ST STE 7
-----------------------------------------------------
City | STURBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01566-1160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-313-9263
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MRS. KATHARINE BRAMBLE
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 818-209-5402
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------