Provider Demographics
NPI:1811294440
Name:YOUNG, TRACY (LICSW)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:E
Other - Last Name:JENNERWEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 RICHMOND SQUARE
Mailing Address - Street 2:350W
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5165
Mailing Address - Country:US
Mailing Address - Phone:401-227-0372
Mailing Address - Fax:877-455-9466
Practice Address - Street 1:1 RICHMOND SQUARE
Practice Address - Street 2:350W
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5165
Practice Address - Country:US
Practice Address - Phone:401-227-0372
Practice Address - Fax:877-455-9466
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0075431041C0700X
MALICSW1270691041C0700X
FLTPSW40221041C0700X
RIISW004821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical