Provider Demographics
NPI:1568744324
Name:EGGER, TRACY L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:L
Last Name:EGGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SHERBROOK CT
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4425
Mailing Address - Country:US
Mailing Address - Phone:631-772-2252
Mailing Address - Fax:
Practice Address - Street 1:35 KREAMER ST
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2337
Practice Address - Country:US
Practice Address - Phone:631-730-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01217716390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program