Provider Demographics
NPI:1366640476
Name:JOSEPH, TRACIE (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JESSE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4513
Mailing Address - Country:US
Mailing Address - Phone:508-994-4378
Mailing Address - Fax:
Practice Address - Street 1:100 N FRONT ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-7350
Practice Address - Country:US
Practice Address - Phone:508-994-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213353101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)