Provider Demographics
NPI:1730645623
Name:MERLAU, TRACY (LMSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MERLAU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 EAST BLVD APT 11
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1536
Mailing Address - Country:US
Mailing Address - Phone:585-326-5604
Mailing Address - Fax:
Practice Address - Street 1:WBHN
Practice Address - Street 2:1519 NYE ROAD, SUITE 110
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489
Practice Address - Country:US
Practice Address - Phone:315-946-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099861104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker