Provider Demographics
NPI:1265656326
Name:KUNKIN, TRACEY F (LMSW)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:F
Last Name:KUNKIN
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 1:161 14TH ST
Mailing Address - Street 2:#2
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4417
Mailing Address - Country:US
Mailing Address - Phone:201-240-6780
Mailing Address - Fax:
Practice Address - Street 1:3974 AMBOY RD
Practice Address - Street 2:3RD FL
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2414
Practice Address - Country:US
Practice Address - Phone:718-984-5050
Practice Address - Fax:718-984-5165
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066954-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical