Provider Demographics
NPI:1053642645
Name:GONCALVES, TRACEY L (MSW)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:GONCALVES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:L
Other - Last Name:MULLIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3770
Mailing Address - Country:US
Mailing Address - Phone:253-697-1951
Mailing Address - Fax:
Practice Address - Street 1:407 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3770
Practice Address - Country:US
Practice Address - Phone:253-697-1951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker