Provider Demographics
NPI:1184718900
Name:BACZEK, ANISA ROSE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANISA
Middle Name:ROSE
Last Name:BACZEK
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 1:9 PRISCILLA ROAD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095
Mailing Address - Country:US
Mailing Address - Phone:860-285-0301
Mailing Address - Fax:
Practice Address - Street 1:36 RUSSELL STREET
Practice Address - Street 2:WHEELER CLINIC
Practice Address - City:NEW BRITIAN
Practice Address - State:CT
Practice Address - Zip Code:06052
Practice Address - Country:US
Practice Address - Phone:860-223-8885
Practice Address - Fax:860-827-3350
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0062771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical