Provider Demographics
NPI:1295483964
Name:VAN DER ZWAN, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:VAN DER ZWAN
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 1:720 BROOKE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4709
Mailing Address - Country:US
Mailing Address - Phone:610-687-2512
Mailing Address - Fax:
Practice Address - Street 1:850 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3220
Practice Address - Country:US
Practice Address - Phone:610-520-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical