Provider Demographics
NPI:1336594258
Name:TRACEY FRAY LCSW
Entity Type:Organization
Organization Name:TRACEY FRAY LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-824-8516
Mailing Address - Street 1:29184 ORANGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33982-8557
Mailing Address - Country:US
Mailing Address - Phone:810-824-8516
Mailing Address - Fax:941-343-2743
Practice Address - Street 1:5104 N LOCKWOOD RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-3311
Practice Address - Country:US
Practice Address - Phone:810-824-8516
Practice Address - Fax:941-343-2743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 1174451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW 11745OtherLICENSE