Provider Demographics
NPI:1568644359
Name:YORK, TRACEY R (MA CACII)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:R
Last Name:YORK
Suffix:
Gender:F
Credentials:MA CACII
Other - Prefix:MS
Other - First Name:TRACEY
Other - Middle Name:SHEAMAN
Other - Last Name:SWOPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CACII
Mailing Address - Street 1:200 NORTH SEVENTH STREET
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046
Mailing Address - Country:US
Mailing Address - Phone:717-273-1710
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:125 S 5TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602
Practice Address - Country:US
Practice Address - Phone:610-685-2188
Practice Address - Fax:610-685-2183
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1317101Y00000X
101YA0400X
PAPC007191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103427639Medicaid