Provider Demographics
NPI:1194790725
Name:BRACALE, LAURA (PMHCNS-BC,APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BRACALE
Suffix:
Gender:F
Credentials:PMHCNS-BC,APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 QUARRY RD STE 160
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4877
Mailing Address - Country:US
Mailing Address - Phone:203-551-7350
Mailing Address - Fax:203-371-0549
Practice Address - Street 1:112 QUARRY RD STE 160
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4877
Practice Address - Country:US
Practice Address - Phone:203-551-7350
Practice Address - Fax:203-371-0549
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002541364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
0354009OtherANCC- ADULT PSYCHIATRIC-MENTAL HEALTH CLINICAL NURSE SPECIALIST
CTE60587OtherREGISTERED NURSE LICENSE
CT002541OtherAPRN LICENSE
CT00235918Medicaid