Provider Demographics
NPI:1184840852
Name:NOBLE, TRACI L (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:L
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12513 PINTAIL CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303-8603
Mailing Address - Country:US
Mailing Address - Phone:219-374-6992
Mailing Address - Fax:
Practice Address - Street 1:12513 PINTAIL CT
Practice Address - Street 2:
Practice Address - City:CEDAR LAKE
Practice Address - State:IN
Practice Address - Zip Code:46303-8603
Practice Address - Country:US
Practice Address - Phone:219-374-6992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004710A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical