Provider Demographics
NPI:1588005573
Name:BECOAT, TRACY ANNETTE (DMIN)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ANNETTE
Last Name:BECOAT
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 N 63RD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2607
Mailing Address - Country:US
Mailing Address - Phone:215-384-6651
Mailing Address - Fax:215-878-8988
Practice Address - Street 1:1989 N 63RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2607
Practice Address - Country:US
Practice Address - Phone:215-384-6651
Practice Address - Fax:215-878-8988
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW011213L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker