Provider Demographics
NPI:1568580793
Name:NICOLOSI, TRACEY E (LMHC, LADC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:E
Last Name:NICOLOSI
Suffix:
Gender:F
Credentials:LMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SAWYER ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-2241
Mailing Address - Country:US
Mailing Address - Phone:978-687-6300
Mailing Address - Fax:978-682-4843
Practice Address - Street 1:599 CANAL ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1244
Practice Address - Country:US
Practice Address - Phone:978-687-6300
Practice Address - Fax:978-682-4843
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA940101YA0400X
MA4504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health