Provider Demographics
NPI:1417015108
Name:PASSARO, TRACY (LPC)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:PASSARO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2201
Mailing Address - Country:US
Mailing Address - Phone:814-723-5545
Mailing Address - Fax:814-723-6355
Practice Address - Street 1:514 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2201
Practice Address - Country:US
Practice Address - Phone:814-723-5545
Practice Address - Fax:814-723-6355
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional