Provider Demographics
NPI:1659721694
Name:HASSELL, TRACIE ROMAINE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:ROMAINE
Last Name:HASSELL
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 1:1624 ROBERT RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5635
Mailing Address - Country:US
Mailing Address - Phone:717-203-1166
Mailing Address - Fax:
Practice Address - Street 1:140A E KING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2832
Practice Address - Country:US
Practice Address - Phone:717-203-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker