Provider Demographics
NPI:1376084921
Name:MADIGAN, TRACEY S (LICSW)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:S
Last Name:MADIGAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1691
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-1691
Mailing Address - Country:US
Mailing Address - Phone:207-560-6033
Mailing Address - Fax:
Practice Address - Street 1:111 HIGH ST APT 4
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6752
Practice Address - Country:US
Practice Address - Phone:207-408-4204
Practice Address - Fax:207-408-4204
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC184511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical