Provider Demographics
NPI:1659376093
Name:HASKELL, TRACY (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:HASKELL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:HULLS COVE
Mailing Address - State:ME
Mailing Address - Zip Code:04644-0037
Mailing Address - Country:US
Mailing Address - Phone:207-664-2994
Mailing Address - Fax:207-667-6998
Practice Address - Street 1:75 STATE ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1923
Practice Address - Country:US
Practice Address - Phone:207-664-2994
Practice Address - Fax:207-667-6998
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC81221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEHA ME0893Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER