Provider Demographics
NPI:1669625398
Name:THE B.R.A.N.C.H
Entity type:Organization
Organization Name:THE B.R.A.N.C.H
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-213-0138
Mailing Address - Street 1:500 EAST 33RD STREET
Mailing Address - Street 2:801
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:312-213-0138
Mailing Address - Fax:
Practice Address - Street 1:500 E 33RD ST
Practice Address - Street 2:801
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4056
Practice Address - Country:US
Practice Address - Phone:312-213-0138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-26
Last Update Date:2008-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.012615251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health