Provider Demographics
NPI:1023164548
Name:BRANCH, KENDRA MARIE (LMHC)
Entity type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:MARIE
Last Name:BRANCH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 SHADOWOOD DR
Mailing Address - Street 2:#308
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1612
Mailing Address - Country:US
Mailing Address - Phone:321-724-0406
Mailing Address - Fax:321-752-3247
Practice Address - Street 1:2212A SARNO RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3083
Practice Address - Country:US
Practice Address - Phone:321-752-3246
Practice Address - Fax:321-752-3247
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH8421OtherLMHC