Provider Demographics
NPI:1730297466
Name:RACSKO, CORLISS J (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:CORLISS
Middle Name:J
Last Name:RACSKO
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MONROE TPKE STE 3B
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-6202
Mailing Address - Country:US
Mailing Address - Phone:203-268-8293
Mailing Address - Fax:203-452-7077
Practice Address - Street 1:227 MONROE TPKE STE 3B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-6202
Practice Address - Country:US
Practice Address - Phone:203-268-8293
Practice Address - Fax:203-452-7077
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional