MEDICARE: MR. TRACY LEIGHTON TIPPETT LCSW

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	1041C0700X	Clinical Social Worker	17671	SC
2	1041C0700X	Clinical Social Worker	LSW3620	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184622383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRACY LEIGHTON TIPPETT LCSW

Provider Business Mailing Address
First Line	:	800 NW 29TH CT
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33311-2436
Country	:	US
Telephone Number	:	954-519-7675
Fax Number	:	866-643-1382

Provider Business Practice Location Address
First Line	:	800 NW 29TH CT
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33311-2436
Country	:	US
Telephone Number	:	855-791-1662
Fax Number	:

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/10/2025

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