Provider Demographics
NPI:1427562941
Name:NEVILLE, TRACY-LEE (LMHC)
Entity Type:Individual
Prefix:
First Name:TRACY-LEE
Middle Name:
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 DEAN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1503
Mailing Address - Country:US
Mailing Address - Phone:516-754-2316
Mailing Address - Fax:
Practice Address - Street 1:40 EXCHANGE PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2701
Practice Address - Country:US
Practice Address - Phone:516-754-2316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health