MEDICARE: MS. ERICA LEE BRANN L.C.S.W.

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	101YM0800X	Mental Health Counselor	428	CO
2	1041C0700X	Clinical Social Worker	428	CO

General Provider Information

NPI Number	:	1598898819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERICA LEE BRANN L.C.S.W.

Provider Business Mailing Address
First Line	:	100 ARAPAHOE AVE STE 12
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5862
Country	:	US
Telephone Number	:	303-875-6567
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ARAPAHOE AVE STE 12
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5862
Country	:	US
Telephone Number	:	303-875-6567
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	04/27/2020

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