Provider Demographics
NPI:1730284803
Name:SUMMER, TRACY ALISON (L-CSW)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ALISON
Last Name:SUMMER
Suffix:
Gender:F
Credentials:L-CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ASTER ST
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-3014
Mailing Address - Country:US
Mailing Address - Phone:631-261-1214
Mailing Address - Fax:
Practice Address - Street 1:32 ASTER ST
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-3014
Practice Address - Country:US
Practice Address - Phone:631-261-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042174-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN78892Medicare ID - Type Unspecified