Provider Demographics
NPI:1679774194
Name:BRODNICKI, CHESTER J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:J
Last Name:BRODNICKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ARNOLDALE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1717
Mailing Address - Country:US
Mailing Address - Phone:860-236-3050
Mailing Address - Fax:
Practice Address - Street 1:93 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3933
Practice Address - Country:US
Practice Address - Phone:203-772-1270
Practice Address - Fax:203-772-0051
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0018891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical