Provider Demographics
NPI:1578833539
Name:DAILY, TRACEY L (LICSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:DAILY
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 HARRY S TRUMAN DR APT 402
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2089
Mailing Address - Country:US
Mailing Address - Phone:301-351-7746
Mailing Address - Fax:
Practice Address - Street 1:713 HARRY S TRUMAN DR APT 402
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-2089
Practice Address - Country:US
Practice Address - Phone:301-351-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500778191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical