Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003201534 |
---|---|
Provider Name | Sarah Branham |
First Address | Kingston, NY 12401-3633 |
Second Address | Kingston, NY 12401-3633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2015 |
Last Update Date | 01/04/2015 |