Provider Demographics
NPI:1588357628
Name:NEW BRANCH THERAPY LLC
Entity type:Organization
Organization Name:NEW BRANCH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRISTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MACCINI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-203-1051
Mailing Address - Street 1:390 WEST ST.
Mailing Address - Street 2:STE. 3 #1034
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02325
Practice Address - Country:US
Practice Address - Phone:508-203-1051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health