Provider Demographics
NPI:1548634470
Name:BRANSON, CAROLYN (LCPC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:BRANSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TIDEWATER CV
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2110
Mailing Address - Country:US
Mailing Address - Phone:207-232-4490
Mailing Address - Fax:207-283-0038
Practice Address - Street 1:222 AUBURN ST
Practice Address - Street 2:STE. 201
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6002
Practice Address - Country:US
Practice Address - Phone:207-232-4490
Practice Address - Fax:207-283-0038
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional