Provider Demographics
NPI:1528567757
Name:PERRY, TRACY ERIN (LMSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ERIN
Last Name:PERRY
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 1:963 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-1831
Mailing Address - Country:US
Mailing Address - Phone:607-734-1447
Mailing Address - Fax:607-767-6042
Practice Address - Street 1:3805 MEADS CREEK RD
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9509
Practice Address - Country:US
Practice Address - Phone:607-962-3100
Practice Address - Fax:607-962-4300
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107460-011041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical