Provider Demographics
NPI:1831861731
Name:HEROUX, TRACY (BA)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:HEROUX
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:FONSECA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8047 HATHAWAY DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-6037
Mailing Address - Country:US
Mailing Address - Phone:860-978-1660
Mailing Address - Fax:
Practice Address - Street 1:433 4TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2803
Practice Address - Country:US
Practice Address - Phone:727-895-8499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health