MEDICARE: TRACI BLAKE SALAMI LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	107157	NY

General Provider Information

NPI Number	:	1164070587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI BLAKE SALAMI LMSW

Provider Business Mailing Address
First Line	:	65 BELMONT AVE APT 2
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-3030
Country	:	US
Telephone Number	:	917-837-6178
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WILLIAM ST FL 6
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-5039
Country	:	US
Telephone Number	:	212-417-3876
Fax Number	:	212-417-3890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	08/28/2019

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