Provider Demographics
NPI:1093983199
Name:ALLEN, TRACY (LSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-5241
Mailing Address - Country:US
Mailing Address - Phone:724-284-4894
Mailing Address - Fax:724-283-8080
Practice Address - Street 1:216 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5241
Practice Address - Country:US
Practice Address - Phone:724-284-4894
Practice Address - Fax:724-283-8080
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126006104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker