Provider Demographics
NPI:1396099107
Name:BRANNON, CARA (LCSW)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:BRANNON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:281 HARTFORD TPKE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4784
Mailing Address - Country:US
Mailing Address - Phone:860-896-5331
Mailing Address - Fax:860-896-5334
Practice Address - Street 1:281 HARTFORD TPKE
Practice Address - Street 2:SUITE 401
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4784
Practice Address - Country:US
Practice Address - Phone:860-896-5331
Practice Address - Fax:860-896-5334
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0080901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical