Provider Demographics
NPI:1720785868
Name:ALAINA BROKAW, LPC, LLC
Entity Type:Organization
Organization Name:ALAINA BROKAW, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROKAW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-859-7949
Mailing Address - Street 1:89 FINLEY ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5615
Mailing Address - Country:US
Mailing Address - Phone:860-859-7949
Mailing Address - Fax:
Practice Address - Street 1:49 TOLLAND TURNPIKE
Practice Address - Street 2:#203F
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042
Practice Address - Country:US
Practice Address - Phone:860-222-7073
Practice Address - Fax:860-215-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health