Provider Demographics
NPI:1053052423
Name:BICKNELL, TATIANA (LMSW)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:BICKNELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ROCKY LEDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1309
Mailing Address - Country:US
Mailing Address - Phone:203-645-6175
Mailing Address - Fax:
Practice Address - Street 1:71 BRADLEY RD UNIT 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2662
Practice Address - Country:US
Practice Address - Phone:203-645-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6242104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker