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NPI Code Detail

MEDICARE: MRS. TRACY ANN LARGETT LMSW

MEDICARE: MRS. TRACY ANN LARGETT 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
11041S0200XSchool Social Worker062821NY

General Provider Information

NPI Number : 1225347198
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACY ANN LARGETT LMSW
Provider Business Mailing Address
First Line : 17513 COUNTY ROUTE 91
Second Line :
City : ADAMS
State : NY
Zip : 13605-2237
Country : US
Telephone Number : 315-465-7979
Fax Number :
Provider Business Practice Location Address
First Line : 1351 WASHINGTON ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-4531
Country : US
Telephone Number : 315-779-5617
Fax Number : 315-785-3769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2010
Last Update Date : 09/27/2010

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