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General NPI Number Information
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NPI Number | 1295254704
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Entity Type | Organization
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Legal Business Name | MARIANNE B. BRANHAM, LCSW, LLC
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2716 FORUM BLVD. SUITE 4B
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City | COLUMBIA
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State | MO
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Zip | 65203
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Country | US
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Telephone | 573-817-9611
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Fax | 573-817-9610
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Provider Business Mailing Address
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Address Line | 2716 FORUM BLVD STE 4B
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City | COLUMBIA
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State | MO
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Zip | 65203-5450
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Country | US
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Telephone | 573-817-9611
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Fax | 573-817-9610
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Authorized Official
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Title or Position | SOLE OWNER
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Name | MARIANNE BRANHAM
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Credential |
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Telephone | 573-817-9611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW005043
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License Number State | MO
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