Provider Demographics
NPI:1417536665
Name:HOLLINGSWORTH, TRACY PHILESIA (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:TRACY
Middle Name:PHILESIA
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:PHILESIA
Other - Last Name:HOLLINGSWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:65 OLDE COLONIAL DR APT 2
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-4216
Mailing Address - Country:US
Mailing Address - Phone:917-837-6797
Mailing Address - Fax:
Practice Address - Street 1:65 OLDE COLONIAL DR APT 2
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-4216
Practice Address - Country:US
Practice Address - Phone:917-837-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0911161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical