1255772901 NPI number — MS. KIMBERLY SUE BRANGOCCIO LMFT, CEAP, IAADC

Table of content: MS. KIMBERLY SUE BRANGOCCIO LMFT, CEAP, IAADC (NPI 1255772901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255772901 NPI number — MS. KIMBERLY SUE BRANGOCCIO LMFT, CEAP, IAADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANGOCCIO
Provider First Name:
KIMBERLY
Provider Middle Name:
SUE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT, CEAP, IAADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255772901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 NE DARTMOOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUKEE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50263-9660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-727-1338
Provider Business Mailing Address Fax Number:
515-727-1340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 E UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
ILH 4-MID
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50316-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-263-2442
Provider Business Practice Location Address Fax Number:
515-263-2463
Provider Enumeration Date:
07/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  00046 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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