Provider Demographics
NPI:1699383315
Name:FLAGG, TRACY (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:FLAGG
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SACOPEE VALLEY MIDDLE SCHOOL
Mailing Address - Street 2:137 SOUTH HIRAM RD
Mailing Address - City:HIRAM
Mailing Address - State:ME
Mailing Address - Zip Code:04041
Mailing Address - Country:US
Mailing Address - Phone:207-625-2450
Mailing Address - Fax:
Practice Address - Street 1:SACOPEE VALLEY MIDDLE SCHOOL
Practice Address - Street 2:137 SOUTH HIRAM RD
Practice Address - City:HIRAM
Practice Address - State:ME
Practice Address - Zip Code:04041
Practice Address - Country:US
Practice Address - Phone:207-625-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC179881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical