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General NPI Number Information
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NPI Number | 1417433137
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Entity Type | Individual
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Provider Name | CAROLINA BRANHAM BCBA
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Gender | Female
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 5730 NORTHWEST PKWY STE 115
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City | SAN ANTONIO
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State | TX
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Zip | 78249-3378
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Country | US
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Telephone | 888-754-0398
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Fax | 954-982-6491
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Provider Business Mailing Address
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Address Line | 6416 NW 5TH WAY
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-6112
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Country | US
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Telephone | 888-754-0398
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Fax | 954-982-6491
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 34187345
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License Number State | TX
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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 | 1-20-44498
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License Number State |
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