Provider Demographics
NPI:1598729832
Name:DI MATTIA, TRACY LEE (LSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:DI MATTIA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1837
Mailing Address - Country:US
Mailing Address - Phone:570-309-7915
Mailing Address - Fax:570-587-1747
Practice Address - Street 1:411 DAVIS ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1837
Practice Address - Country:US
Practice Address - Phone:570-309-7915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)