Provider Demographics
NPI:1982611364
Name:TRACY, THOMAS (LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:TRACY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 RANDOLPH DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1148
Mailing Address - Country:US
Mailing Address - Phone:856-513-5054
Mailing Address - Fax:856-629-5150
Practice Address - Street 1:21 RANDOLPH DR
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1148
Practice Address - Country:US
Practice Address - Phone:856-513-5054
Practice Address - Fax:856-513-5054
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44 SC047576001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical