Provider Demographics
NPI:1841707544
Name:GRIFFITH, TRACY HARMON (DSW LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:HARMON
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:DSW LCSW
Other - Prefix:MR
Other - First Name:TRACY
Other - Middle Name:HARMON
Other - Last Name:GRIFFITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DSW LCSW
Mailing Address - Street 1:1120 CANTRELL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3027
Mailing Address - Country:US
Mailing Address - Phone:215-356-2531
Mailing Address - Fax:
Practice Address - Street 1:1120 CANTRELL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3027
Practice Address - Country:US
Practice Address - Phone:215-356-2531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7393-C1041C0700X
PACW0151141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical