Provider Demographics
NPI:1104936814
Name:BRZEZINSKI, RONNIE ISRAELSON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RONNIE
Middle Name:ISRAELSON
Last Name:BRZEZINSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:RONNIE
Other - Middle Name:I
Other - Last Name:BRZEZINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:20 NOVEMBER LN
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1017
Mailing Address - Country:US
Mailing Address - Phone:860-628-7674
Mailing Address - Fax:860-628-7674
Practice Address - Street 1:355 HIGHLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2551
Practice Address - Country:US
Practice Address - Phone:860-628-9259
Practice Address - Fax:860-628-7674
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP400574OtherOXFORD
CT140000839CT01OtherANTHEM BLUE CROSS/BLUE SH
CT7496215OtherVALUE OPTIONS