Provider Demographics
NPI:1184359192
Name:ESMOND, TRACIE (LCSW)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:ESMOND
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 1:2004 LEWIS TURNER BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1362
Mailing Address - Country:US
Mailing Address - Phone:850-226-7893
Mailing Address - Fax:850-226-8081
Practice Address - Street 1:2004 LEWIS TURNER BLVD STE B
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1362
Practice Address - Country:US
Practice Address - Phone:850-226-7893
Practice Address - Fax:850-226-8081
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW202311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty