Provider Demographics
NPI:1578248456
Name:BLUMROSEN, TRACEY LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEE
Last Name:BLUMROSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:LEE
Other - Last Name:BLUMENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4713 BELLVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-5303
Mailing Address - Country:US
Mailing Address - Phone:832-689-8860
Mailing Address - Fax:
Practice Address - Street 1:4713 BELLVIEW ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-5303
Practice Address - Country:US
Practice Address - Phone:832-689-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX696501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical