Provider Demographics
NPI:1922526748
Name:TRACEY CARDELLO LCSW P.C.
Entity Type:Organization
Organization Name:TRACEY CARDELLO LCSW P.C.
Other - Org Name:TLC COUNSELING & WELLNESS STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW R
Authorized Official - Phone:516-996-2145
Mailing Address - Street 1:47 OLD BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-933-4000
Mailing Address - Fax:516-933-4000
Practice Address - Street 1:47 OLD BROADWAY
Practice Address - Street 2:
Practice Address - City:GARDEN CITY PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-5012
Practice Address - Country:US
Practice Address - Phone:516-996-2145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TACEY CARDELLO LCSW P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-31
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0572031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty