Provider Demographics
NPI:1902358807
Name:BISHOP, TRACY (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CHEWS LANDING RD STE 21
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2769
Mailing Address - Country:US
Mailing Address - Phone:856-230-2975
Mailing Address - Fax:856-599-1034
Practice Address - Street 1:1405 CHEWS LANDING RD STE 21
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2769
Practice Address - Country:US
Practice Address - Phone:856-230-2975
Practice Address - Fax:856-599-1034
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052727001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical