Bronecki, Roberta A
Bronecki, Roberta A is an individual health care provider with primary practice located at 124 Grayside Ave , Mauston WI 53948-1913. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Bronecki, Roberta A can be contacted via phone (608) 847-7575.Contact Information
Primary practice address
124 Grayside Ave
Mauston WI 53948-1913
Phone: (608) 847-7575
Fax: (608) 847-3096
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 7163 | Wisconsin |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 7163-123 | Wisconsin |
Profile Details
| NPI number | 1205830965 |
|---|---|
| LBN Legal business name | Bronecki, Roberta A |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 10th, 2005 |
| Last updated | May 23rd, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205830965 | NPPES |
| Other | 11988111 | CAQH | |
| MEDICAID | 40983800 | CAQH | |
| Other | 1013375104 | CAQH |
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