Provider Demographics
NPI:1578018685
Name:GUZMAN MORALES, TRACY (LICSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:GUZMAN MORALES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4945 WASHINGTON ST APT 107
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-2187
Mailing Address - Country:US
Mailing Address - Phone:617-983-4222
Mailing Address - Fax:
Practice Address - Street 1:640 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2555
Practice Address - Country:US
Practice Address - Phone:617-983-4227
Practice Address - Fax:617-983-4246
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical