Provider Demographics
NPI:1477886349
Name:RISKIN, BREANA (LCSW)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:
Last Name:RISKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 BROAD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3261
Mailing Address - Country:US
Mailing Address - Phone:203-878-6198
Mailing Address - Fax:
Practice Address - Street 1:266 BROAD ST
Practice Address - Street 2:SUITE A
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3261
Practice Address - Country:US
Practice Address - Phone:203-878-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008098104100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program