Healthcare Provider Details

I. General information

NPI: 1619172194
Provider Name (Legal Business Name): CAROLYN A. TRASKO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28312 LEWES GEORGETOWN HWY
MILTON DE
19968-3115
US

IV. Provider business mailing address

32350 PRESERVE DR
LEWES DE
19958-5977
US

V. Phone/Fax

Practice location:
  • Phone: 302-827-3356
  • Fax:
Mailing address:
  • Phone: 302-827-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number004350
License Number StateCT

VIII. Authorized Official

Name: MS. CAROLYN ANN TRASKO
Title or Position: OWNER
Credential: LCSW
Phone: 860-334-1477