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NPI Code Detail

MEDICARE: ROBERTA A BRONECKI LCSW

MEDICARE: ROBERTA A BRONECKI LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker7163WI
21041C0700XClinical Social Worker7163-123WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111988111OTHERCAQH
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31013375104OTHERWIAGENCY NPI NUMBER

General Provider Information

NPI Number : 1205830965
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTA A BRONECKI LCSW
Provider Business Mailing Address
First Line : PO BOX 359
Second Line :
City : MAUSTON
State : WI
Zip : 53948-0359
Country : US
Telephone Number : 608-847-7575
Fax Number : 608-847-3096
Provider Business Practice Location Address
First Line : 124 GRAYSIDE AVE
Second Line :
City : MAUSTON
State : WI
Zip : 53948-1913
Country : US
Telephone Number : 608-847-7575
Fax Number : 608-847-3096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 05/23/2019

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Directions to “ ROBERTA A BRONECKI LCSW” Practice Location

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