Provider Demographics
NPI:1548996044
Name:BRANCH, MELISSA RENA (RBT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RENA
Last Name:BRANCH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:RENA
Other - Last Name:BRANCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 ANDERSON WAY
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-1601
Mailing Address - Country:US
Mailing Address - Phone:912-342-0997
Mailing Address - Fax:912-342-4977
Practice Address - Street 1:106 ANDERSON WAY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1601
Practice Address - Country:US
Practice Address - Phone:912-342-0997
Practice Address - Fax:912-342-4977
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty