Provider Demographics
NPI:1689779985
Name:BOYD, TRACY L (LICSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:BOYD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1357 FORESTEDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-5119
Mailing Address - Country:US
Mailing Address - Phone:206-919-3595
Mailing Address - Fax:
Practice Address - Street 1:1301 SEMINOLE BLVD STE 111B
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770
Practice Address - Country:US
Practice Address - Phone:727-754-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL125101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8902748OtherL&I CRIME VICTIMS