Healthcare Provider Details

I. General information

NPI: 1437263969
Provider Name (Legal Business Name): CAROL ANNE BRACKONESKI LCSW, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 BRIDGE ST.
EAST WINDSOR CT
06088-9679
US

IV. Provider business mailing address

38 BRIDGE ST. P.O. BOX 486
EAST WINDSOR CT
06088-9679
US

V. Phone/Fax

Practice location:
  • Phone: 860-292-1212
  • Fax: 860-292-1671
Mailing address:
  • Phone: 860-292-1212
  • Fax: 860-292-1671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000040
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004216
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number018594
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: