Provider Demographics
NPI:1831515980
Name:HOBERMAN, TRACY LYNNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNNE
Last Name:HOBERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:LYNNE
Other - Last Name:HOBERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:6651 BALBOA BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5529
Mailing Address - Country:US
Mailing Address - Phone:818-702-1250
Mailing Address - Fax:
Practice Address - Street 1:6651 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5529
Practice Address - Country:US
Practice Address - Phone:818-702-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS162721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical