Provider Demographics
NPI:1467758029
Name:TRACY, JULIE ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:TRACY
Suffix:
Gender:F
Credentials:LMSW
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 160
Mailing Address - Street 2:284 MAIN STREET SUITE 320
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157-0160
Mailing Address - Country:US
Mailing Address - Phone:518-295-8407
Mailing Address - Fax:518-295-8724
Practice Address - Street 1:284 MAIN ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157-0160
Practice Address - Country:US
Practice Address - Phone:518-295-8407
Practice Address - Fax:518-295-8724
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083111-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0300428OtherAGENCY MEDICAID