Provider Demographics
NPI:1003411596
Name:BRANNOCK, CAROLINE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:BRANNOCK
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-2014
Mailing Address - Country:US
Mailing Address - Phone:410-603-7298
Mailing Address - Fax:
Practice Address - Street 1:10 6TH AVE W
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-0028
Practice Address - Country:US
Practice Address - Phone:304-525-8014
Practice Address - Fax:304-525-8026
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.01573103K00000X
WV1-22-61579103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst