Provider Demographics
NPI:1871672774
Name:BRACCIO, SUSAN J (MSWLCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:BRACCIO
Suffix:
Gender:F
Credentials:MSWLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON DEPOT
Mailing Address - State:CT
Mailing Address - Zip Code:06794-1018
Mailing Address - Country:US
Mailing Address - Phone:860-868-1864
Mailing Address - Fax:860-868-1864
Practice Address - Street 1:29 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3507
Practice Address - Country:US
Practice Address - Phone:860-354-1111
Practice Address - Fax:860-868-1864
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0039741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140003974CT02OtherANTHEM BLUE CROSS BLUE SH