Provider Demographics
NPI:1629349402
Name:KASHNER ROSS, TRACY (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:KASHNER ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:KASHNER
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:230 W 13TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7746
Mailing Address - Country:US
Mailing Address - Phone:212-229-1935
Mailing Address - Fax:
Practice Address - Street 1:230 W 13TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7746
Practice Address - Country:US
Practice Address - Phone:212-229-1935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069992-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY069992-1OtherNY STATE LICENSE