Provider Demographics
NPI:1194487892
Name:ROZANSKY, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ROZANSKY
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 1:163 LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6269
Mailing Address - Country:US
Mailing Address - Phone:201-895-4256
Mailing Address - Fax:
Practice Address - Street 1:163 LINDEN RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6269
Practice Address - Country:US
Practice Address - Phone:201-895-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-10
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05320300104100000X, 1041C0700X
NY093720-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker