Provider Demographics
NPI:1922208537
Name:NEWBERN, TRACY MARIE (LMSW, LISW-S, LCSW)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MARIE
Last Name:NEWBERN
Suffix:
Gender:F
Credentials:LMSW, LISW-S, LCSW
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:MARIE
Other - Last Name:NEWBERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 352024
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43635-2024
Mailing Address - Country:US
Mailing Address - Phone:615-975-9068
Mailing Address - Fax:855-450-2036
Practice Address - Street 1:2138 LOXLEY RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-5015
Practice Address - Country:US
Practice Address - Phone:419-902-2010
Practice Address - Fax:855-450-2036
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-21
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010743291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical