1639235534 NPI number — CAROLYN ANN TRASKO MSW, LCSW

Table of content: CAROLYN ANN TRASKO MSW, LCSW (NPI 1639235534)

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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