Provider Demographics
NPI:1205208741
Name:DIAMOND-CROMWELL, TRACY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:DIAMOND-CROMWELL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:DIAMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5306 GLEN ARM RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9301
Mailing Address - Country:US
Mailing Address - Phone:410-622-2822
Mailing Address - Fax:
Practice Address - Street 1:12107 LONG GREEN PIKE
Practice Address - Street 2:
Practice Address - City:GLEN ARM
Practice Address - State:MD
Practice Address - Zip Code:21057-9200
Practice Address - Country:US
Practice Address - Phone:443-200-4814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD077671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical