Provider Demographics
NPI:1093320707
Name:NEWMAN, TRACY LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:TROWBRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RCSWI
Mailing Address - Street 1:1299 BEDFORD DR STE B2
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1900
Mailing Address - Country:US
Mailing Address - Phone:321-622-8104
Mailing Address - Fax:321-547-4046
Practice Address - Street 1:1299 BEDFORD DR STE B2
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1900
Practice Address - Country:US
Practice Address - Phone:321-622-8104
Practice Address - Fax:321-547-4046
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW178591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical