Provider Demographics
NPI:1932564150
Name:RICHARD, TRACEY JOY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:JOY
Last Name:RICHARD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:TRACEY
Other - Middle Name:JOY
Other - Last Name:BARTHOLOMEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:GOOD SAMARITAN MEDICAL CENTER
Mailing Address - Street 2:235 NORTH PEARL STREET
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3308
Mailing Address - Country:US
Mailing Address - Phone:508-427-2420
Mailing Address - Fax:508-427-3363
Practice Address - Street 1:GOOD SAMARITAN MEDICAL CENTER
Practice Address - Street 2:235 NORTH PEARL STREET
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-427-2420
Practice Address - Fax:508-427-3363
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health