Provider Demographics
NPI:1164070587
Name:SALAMI, TRACI BLAKE (LMSW)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:BLAKE
Last Name:SALAMI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BELMONT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-3030
Mailing Address - Country:US
Mailing Address - Phone:917-837-6178
Mailing Address - Fax:
Practice Address - Street 1:100 WILLIAM ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5039
Practice Address - Country:US
Practice Address - Phone:212-417-3876
Practice Address - Fax:212-417-3890
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107157104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker