Provider Demographics
NPI:1336720788
Name:TRACY MARGOLIN LMFT LLC
Entity Type:Organization
Organization Name:TRACY MARGOLIN LMFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-273-3531
Mailing Address - Street 1:10 MARY JANE LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2806
Mailing Address - Country:US
Mailing Address - Phone:203-273-3531
Mailing Address - Fax:
Practice Address - Street 1:10 MARY JANE LN
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2806
Practice Address - Country:US
Practice Address - Phone:203-273-3531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health