Provider Demographics
NPI:1336610120
Name:NIECKARZ, TRACEY DIANE (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:DIANE
Last Name:NIECKARZ
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MALTA AVE
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-1529
Mailing Address - Country:US
Mailing Address - Phone:518-884-7195
Mailing Address - Fax:518-884-7101
Practice Address - Street 1:300 WOOD RD
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2246
Practice Address - Country:US
Practice Address - Phone:518-884-7290
Practice Address - Fax:518-884-7286
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0556381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical