Provider Demographics
NPI:1104394162
Name:FOGARTY, TRACY ELIZABETH
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ELIZABETH
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FLAT 1 A 54 BRUNSWICK PLACE
Mailing Address - Street 2:
Mailing Address - City:HOVE
Mailing Address - State:UK
Mailing Address - Zip Code:BN3 1NB
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FLAT 1 A 54 BRUNSWICK PLACE
Practice Address - Street 2:
Practice Address - City:HOVE
Practice Address - State:UK
Practice Address - Zip Code:BN3 1NB
Practice Address - Country:GB
Practice Address - Phone:447-383-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10317631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical