Provider Demographics
NPI:1013264712
Name:ZAMBRZYCKA-BROOMHEAD, ADRIANNA OLGA (LCSW, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANNA
Middle Name:OLGA
Last Name:ZAMBRZYCKA-BROOMHEAD
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2218
Mailing Address - Country:US
Mailing Address - Phone:860-430-1762
Mailing Address - Fax:
Practice Address - Street 1:2300 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2218
Practice Address - Country:US
Practice Address - Phone:860-430-1762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0063751041C0700X
CT1096576103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical