Provider Demographics
NPI:1487668877
Name:RICHARDS, TRACY M (MSW)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:M
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:MARIE
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2151 LINGLESTOWN ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110
Mailing Address - Country:US
Mailing Address - Phone:717-540-1313
Mailing Address - Fax:717-540-1416
Practice Address - Street 1:2151 LINGLESTOWN ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110
Practice Address - Country:US
Practice Address - Phone:717-540-1313
Practice Address - Fax:717-540-1416
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0080011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03127001OtherCAPITAL BLUE SHIELD