Provider Demographics
NPI:1124608054
Name:TRACIE PRELI-DERWIN, LCSW, PLLC
Entity type:Organization
Organization Name:TRACIE PRELI-DERWIN, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRELI-DERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-414-3200
Mailing Address - Street 1:125 MAIN STREET PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-9998
Mailing Address - Country:US
Mailing Address - Phone:860-414-3200
Mailing Address - Fax:860-414-3625
Practice Address - Street 1:266 MERIDEN AVE
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3629
Practice Address - Country:US
Practice Address - Phone:860-414-3200
Practice Address - Fax:860-414-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty