Provider Demographics
NPI:1831788678
Name:TRACEY E REED
Entity type:Organization
Organization Name:TRACEY E REED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:585-794-7378
Mailing Address - Street 1:94 BRUSH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3004
Mailing Address - Country:US
Mailing Address - Phone:585-794-7378
Mailing Address - Fax:
Practice Address - Street 1:485 TITUS AVE STE F1
Practice Address - Street 2:
Practice Address - City:IRONDEQUOIT
Practice Address - State:NY
Practice Address - Zip Code:14617-3535
Practice Address - Country:US
Practice Address - Phone:585-794-7378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty