Provider Demographics
NPI:1588042238
Name:CARROLL, TRACY M
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5984 S PRINCE ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2083
Mailing Address - Country:US
Mailing Address - Phone:508-439-9487
Mailing Address - Fax:
Practice Address - Street 1:5984 S PRINCE ST
Practice Address - Street 2:STE. 101
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2083
Practice Address - Country:US
Practice Address - Phone:303-730-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker