Provider Demographics
NPI:1912665852
Name:PAWLUKANIS, TRACY A (LSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:PAWLUKANIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 GEORGIA TAVERN RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-8751
Mailing Address - Country:US
Mailing Address - Phone:848-459-3211
Mailing Address - Fax:
Practice Address - Street 1:35 BEAVERSON BLVD STE 12A
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7870
Practice Address - Country:US
Practice Address - Phone:732-996-4166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL067224800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker