Healthcare Provider Details

I. General information

NPI: 1194790725
Provider Name (Legal Business Name): LAURA BRACALE PMHCNS-BC,APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 11/21/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 QUARRY RD STE 160
TRUMBULL CT
06611-4877
US

IV. Provider business mailing address

112 QUARRY RD STE 160
TRUMBULL CT
06611-4877
US

V. Phone/Fax

Practice location:
  • Phone: 203-551-7350
  • Fax: 203-371-0549
Mailing address:
  • Phone: 203-551-7350
  • Fax: 203-371-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number002541
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: