Provider Demographics
NPI:1639235534
Name:TRASKO, CAROLYN ANN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:TRASKO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:ZAKARIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:57 OLD JEWETT CITY RD
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06365-8010
Mailing Address - Country:US
Mailing Address - Phone:860-887-7647
Mailing Address - Fax:860-887-3104
Practice Address - Street 1:57 OLD JEWETT CITY RD
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:CT
Practice Address - Zip Code:06365-8010
Practice Address - Country:US
Practice Address - Phone:860-887-7647
Practice Address - Fax:860-887-3104
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2017-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCAC-3682101YA0400X
CT0043501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT191022OtherMHN PROVIDER ID
CT336119OtherVALUE OPTIONS PROVIDER ID
CT161622942OtherTAX IDENTIFICATION NUMBER
CT706412000OtherMAGELLAN PROVIDER ID
CT2033944OtherCIGNA PROVIDER ID
CTP3050702OtherOXFORD PROVIDER ID
CT140004350CT07OtherANTHEM PROVIDER ID
CT0007721113OtherAETNA PROVIDER ID
CT004254710Medicaid