Provider Demographics
NPI:1841433158
Name:TRACY FOX GALLUPPI, LCSW, LLC
Entity type:Organization
Organization Name:TRACY FOX GALLUPPI, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:FOX
Authorized Official - Last Name:GALLUPPI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:732-991-3809
Mailing Address - Street 1:904 HAZELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1219
Mailing Address - Country:US
Mailing Address - Phone:732-377-9204
Mailing Address - Fax:
Practice Address - Street 1:24 N 3RD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2429
Practice Address - Country:US
Practice Address - Phone:732-991-3809
Practice Address - Fax:732-640-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05279300261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)