| Marianne B. Branham, Lcsw, Llc | |
|
2716 Forum Blvd. Suite 4b Columbia MO 65203 | |
| (573) 817-9611 | |
| (573) 817-9610 |
| Full Name | Marianne B. Branham, Lcsw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2716 Forum Blvd., Columbia, Missouri |
| Authorized Official Name and Position | Marianne Branham (SOLE OWNER) |
| Authorized Official Contact | 5738179611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marianne B. Branham, Lcsw, Llc 2716 Forum Blvd Ste 4b Columbia MO 65203-5450 Ph: (573) 817-9611 | Marianne B. Branham, Lcsw, Llc 2716 Forum Blvd. Suite 4b Columbia MO 65203 Ph: (573) 817-9611 |
| NPI Number | 1295254704 |
|---|---|
| Provider Enumeration Date | 09/15/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 9032476387 |
|---|---|
| Medicare Enrollment ID | O20171122000720 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295254704 | NPI | - | NPPES |
| 10849131 | Other | MO | CAQH |
| 1124105622 | Other | MO | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW005043 (Missouri) | Primary |
| Provider Name | Marianne B Branham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124105622 PECOS PAC ID: 2567510597 Enrollment ID: I20090501000198 |
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