MEDICARE: ASHLEY NICHOLE BRANHAM LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	82398	CA

General Provider Information

NPI Number	:	1194863464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICHOLE BRANHAM LCSW

Provider Business Mailing Address
First Line	:	PO BOX 4625
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91412-4625
Country	:	US
Telephone Number	:	804-397-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 WILSHIRE BLVD FL 19
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4920
Country	:	US
Telephone Number	:	805-764-9651
Fax Number	:	747-330-1670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	03/06/2026

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