Provider Demographics
NPI:1437263969
Name:BRACKONESKI, CAROL ANNE (LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:BRACKONESKI
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 BRIDGE ST.
Mailing Address - Street 2:P.O. BOX 486
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088-9679
Mailing Address - Country:US
Mailing Address - Phone:860-292-1212
Mailing Address - Fax:860-292-1671
Practice Address - Street 1:38 BRIDGE ST.
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088-9679
Practice Address - Country:US
Practice Address - Phone:860-292-1212
Practice Address - Fax:860-292-1671
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000040101YA0400X
CT0042161041C0700X
CT018594164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse