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NPI Code Detail

MEDICARE: DOMINIC M BRANCH LSW

MEDICARE: DOMINIC M BRANCH LSW
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
1104100000XSocial Worker150.110200IL

General Provider Information

NPI Number : 1861329047
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIC M BRANCH LSW
Provider Business Mailing Address
First Line : 2930 W GRAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-4308
Country : US
Telephone Number : 708-603-8379
Fax Number :
Provider Business Practice Location Address
First Line : 2930 W GRAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-4308
Country : US
Telephone Number : 872-817-9858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2026
Last Update Date : 05/04/2026

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