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General NPI Number Information
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NPI Number | 1447125869
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Entity Type | Organization
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Legal Business Name | BRANCH LANE PSYCHOTHERAPY
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 11/01/2025
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Provider Practice Location Address
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Address Line | 248 W 35TH ST RM 406
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City | NEW YORK
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State | NY
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Zip | 10001-2513
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Country | US
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Telephone | 347-377-0973
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Fax |
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Provider Business Mailing Address
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Address Line | 112 BARTRAM OAKS WALK STE 104 #600832
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City | SAINT JOHNS
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State | FL
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Zip | 32259-3268
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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 | MANAGER
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Name | ERICA OPPENHEIMER
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Credential | LCSW
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Telephone | 347-377-0973
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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 |
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License Number State |
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