Healthcare Provider Details

I. General information

NPI: 1457186041
Provider Name (Legal Business Name): DENISE BYCZKO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 BURBANK AVE
SUFFIELD CT
06078-1459
US

IV. Provider business mailing address

61 WEBB ST
WINDSOR LOCKS CT
06096-2516
US

V. Phone/Fax

Practice location:
  • Phone: 860-301-7735
  • Fax:
Mailing address:
  • Phone: 860-301-7735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10345
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: