MEDICARE: CHRISTOPHER BRANHAM CSW

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	175T00000X	Peer Specialist
2	104100000X	Social Worker	258967	KY

General Provider Information

NPI Number	:	1376990515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER BRANHAM CSW

Provider Business Mailing Address
First Line	:	755 STOCKTON RD.
Second Line	:
City	:	WALLINGFORD
State	:	KY
Zip	:	41093
Country	:	US
Telephone Number	:	606-755-0194
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 CW STEVENS BLVD
Second Line	:
City	:	GRAYSON
State	:	KY
Zip	:	41143-2014
Country	:	US
Telephone Number	:	606-329-8588
Fax Number	:

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	08/01/2024

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