Provider Demographics
NPI:1003255449
Name:MURPHY, TRACY KIM (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:KIM
Last Name:MURPHY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:KIM
Other - Last Name:BIAVATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1030 SPRING VILLAS PT
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5242
Mailing Address - Country:US
Mailing Address - Phone:321-204-8033
Mailing Address - Fax:
Practice Address - Street 1:1030 SPRING VILLAS PT
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5242
Practice Address - Country:US
Practice Address - Phone:321-204-8033
Practice Address - Fax:845-634-1911
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW167611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355940Medicaid
NY1285628552OtherAGENICES
NYWVE061OtherMEDICARE #