Provider Demographics
NPI:1265579304
Name:MAYER, TRACY A (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:MAYER
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:PO BOX 1649
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53547-1649
Mailing Address - Country:US
Mailing Address - Phone:608-757-5238
Mailing Address - Fax:
Practice Address - Street 1:3530 N. COUNTY TRUNK HIGHWAY F
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53547-1649
Practice Address - Country:US
Practice Address - Phone:608-757-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72681231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical