Provider Demographics
NPI:1124122742
Name:BRANCH, CURTIS WOOD (PHD)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:WOOD
Last Name:BRANCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WASHINGTON PLACE
Mailing Address - Street 2:ROOM 329
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-3174
Mailing Address - Country:US
Mailing Address - Phone:973-645-3042
Mailing Address - Fax:973-622-4813
Practice Address - Street 1:20 WASHINGTON PLACE
Practice Address - Street 2:ROOM 329
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-3174
Practice Address - Country:US
Practice Address - Phone:973-645-3042
Practice Address - Fax:973-622-4813
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4046103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical