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General NPI Number Information
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NPI Number | 1255236527
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Entity Type | Organization
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Legal Business Name | BESPOKE THERAPY CT, PLLC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 330 MERWIN AVE SUITE D1
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City | MILFORD
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State | CT
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Zip | 06460
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Country | US
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Telephone | 859-547-2012
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Fax |
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Provider Business Mailing Address
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Address Line | 167 CHERRY ST STE 147
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City | MILFORD
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State | CT
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Zip | 06460-3466
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | JUSTIN BRANHAM
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Credential | APRN
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Telephone | 859-547-2012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | NULL
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