Individual
DELISA BRANCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1633 N DOVER ST, PHILADELPHIA, PA 19121-2707
(215) 796-8309
Mailing address
1633 N DOVER ST, PHILADELPHIA, PA 19121-2707
(215) 796-8309
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH005179
PA
Other
Enumeration date
02/22/2021
Last updated
03/12/2021
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