Provider Demographics
NPI:1114238631
Name:PEYMANN, TRACY ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRACY ANNE
Middle Name:
Last Name:PEYMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1650
Mailing Address - Country:US
Mailing Address - Phone:631-244-5944
Mailing Address - Fax:631-244-5979
Practice Address - Street 1:379 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1650
Practice Address - Country:US
Practice Address - Phone:631-244-5944
Practice Address - Fax:631-244-5979
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0811541041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00659412Medicaid