Provider Demographics
NPI:1922245232
Name:BRACKEN, TOMIKO TANI (LCSW)
Entity Type:Individual
Prefix:
First Name:TOMIKO
Middle Name:TANI
Last Name:BRACKEN
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 1:28626 PONDEROSA ST
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-4744
Mailing Address - Country:US
Mailing Address - Phone:661-713-9989
Mailing Address - Fax:
Practice Address - Street 1:28416 CONSTELLATION RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5081
Practice Address - Country:US
Practice Address - Phone:661-713-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS236361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical