1639235534 NPI number — CAROLYN ANN TRASKO MSW, LCSW

Table of content: ANDREW SENZON DC (NPI 1003979519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639235534 NPI number — CAROLYN ANN TRASKO MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRASKO
Provider First Name:
CAROLYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZAKARIAN
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639235534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 OLD JEWETT CITY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06365-8010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-887-7647
Provider Business Mailing Address Fax Number:
860-887-3104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 OLD JEWETT CITY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06365-8010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-887-7647
Provider Business Practice Location Address Fax Number:
860-887-3104
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CAC-3682 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 004350 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 191022 . This is a "MHN PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 336119 . This is a "VALUE OPTIONS PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 161622942 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 706412000 . This is a "MAGELLAN PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2033944 . This is a "CIGNA PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3050702 . This is a "OXFORD PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 140004350CT07 . This is a "ANTHEM PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0007721113 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004254710 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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