Provider Demographics
NPI:1568425627
Name:ROSS-FARES, TRACY L (LCSW, C-ASWCM)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:ROSS-FARES
Suffix:
Gender:F
Credentials:LCSW, C-ASWCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CHILD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214-5005
Mailing Address - Country:US
Mailing Address - Phone:904-270-4294
Mailing Address - Fax:904-270-4457
Practice Address - Street 1:2104 MASSEY AVENUE
Practice Address - Street 2:NAVAL STATION, MAYPORT
Practice Address - City:MAYPORT
Practice Address - State:FL
Practice Address - Zip Code:32228
Practice Address - Country:US
Practice Address - Phone:904-270-4294
Practice Address - Fax:904-270-4457
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 4952104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker