MEDICARE: JESSICA LAUREN 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	0904007874	VA
2	104100000X	Social Worker	0904007874	VA

General Provider Information

NPI Number	:	1356530729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LAUREN BRANHAM LCSW

Provider Business Mailing Address
First Line	:	1301 FIRST COLONIAL RD STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2263
Country	:	US
Telephone Number	:	757-632-3819
Fax Number	:	757-668-7950

Provider Business Practice Location Address
First Line	:	1301 FIRST COLONIAL RD STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2263
Country	:	US
Telephone Number	:	757-632-3819
Fax Number	:

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

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	09/06/2024

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