Richard J Bronecki, LISW, CEAP, SAP
Individual provider Active NPI Social Worker · Beaver Dam, WI
NPI 1497767040 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1497767040
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 3034123 (WI)
- Practice address
- 108 N Lincoln Ave
Beaver Dam, WI 53916-2110 - Phone
- (920) 887-8751
- Fax
- (920) 922-7440
- NPI assigned
- Aug 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3034123 | WI | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Affiliated Counseling Center, Inc | Past |
Accepting new patients | |
| Lakefront Wellness Center, SC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 3034123 | WI | Yes |
Addresses
Primary practice location
108 N Lincoln Ave
Beaver Dam, WI 53916-2110
Mailing address
1040 E Capitol Dr
Hartland, WI 53029-2214
Phone (262) 623-1033
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39241100 | Medicaid | WI |
Other providers in Beaver Dam, WI
- Shelby Ann Brandsma
- Kailin M Brath
- Douglas Earl Bricker
- Anthony Thomas Bridgeman
- Megan Brisbois
- Meagan Brown
- Rebecca Buchda
- William Henry Bull V
- Jami Nicole Burg
- Laura Burkett
All providers in Beaver Dam, WI · Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.