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General NPI Number Information
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NPI Number | 1396595005
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Entity Type | Individual
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Provider Name | MALORIE JAMELIA BRANCH
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Gender | Female
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 628 MONTEZUMA ST
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City | RIO VISTA
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State | CA
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Zip | 94571-1622
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Country | US
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Telephone | 707-374-5243
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 MARINA VILLAGE PKWY STE 100
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City | ALAMEDA
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State | CA
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Zip | 94501-1078
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Country | US
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Telephone | 415-305-6258
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 121253
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 121253
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License Number State | CA
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