Provider Demographics
NPI:1255571006
Name:CARPENTER, TRACY ELLEN (SAP, SSW, CAC, LPC)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ELLEN
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:SAP, SSW, CAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1909
Mailing Address - Country:US
Mailing Address - Phone:856-547-5651
Mailing Address - Fax:856-546-9595
Practice Address - Street 1:103 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1909
Practice Address - Country:US
Practice Address - Phone:856-547-5651
Practice Address - Fax:856-546-9595
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00331500101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health