Provider Demographics
NPI:1306042379
Name:BARLOW, TRACEY BETH (SOCIAL WORKER)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:BETH
Last Name:BARLOW
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E VARGO RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-9319
Mailing Address - Country:US
Mailing Address - Phone:607-592-8569
Mailing Address - Fax:
Practice Address - Street 1:25 E VARGO RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-9319
Practice Address - Country:US
Practice Address - Phone:607-592-8569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614075163W00000X
NY213027-1164W00000X
NY094647104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01956183Medicaid