Provider Demographics
NPI:1568966430
Name:TRACY DURKIN, LCSW INC.
Entity Type:Organization
Organization Name:TRACY DURKIN, LCSW INC.
Other - Org Name:TRACY DURKIN, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-758-0550
Mailing Address - Street 1:628 SHREWSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4932
Mailing Address - Country:US
Mailing Address - Phone:732-758-0550
Mailing Address - Fax:732-758-0280
Practice Address - Street 1:628 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4932
Practice Address - Country:US
Practice Address - Phone:732-758-0550
Practice Address - Fax:732-758-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC01169800251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health