Provider Demographics
NPI:1013054071
Name:LEWANDOWSKI, TRACY COLEMAN
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:COLEMAN
Last Name:LEWANDOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S PALMETTO AVE STE 200 # R
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4336
Mailing Address - Country:US
Mailing Address - Phone:386-248-0712
Mailing Address - Fax:386-248-0916
Practice Address - Street 1:150 S PALMETTO AVE STE 200 # R
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4336
Practice Address - Country:US
Practice Address - Phone:386-248-0712
Practice Address - Fax:386-248-0916
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker