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NPI Code Detail

MEDICARE: MRS. TRACEY ANNE BRUBAKER LCSW, CMSW

MEDICARE: MRS. TRACEY ANNE BRUBAKER LCSW, CMSW
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
11041C0700XClinical Social WorkerC005570NC

Other Identifiers

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

General Provider Information

NPI Number : 1295945707
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACEY ANNE BRUBAKER LCSW, CMSW
Provider Business Mailing Address
First Line : 8415 FOXBRIDGE DR
Second Line :
City : MATTHEWS
State : NC
Zip : 28104-7884
Country : US
Telephone Number : 704-497-4774
Fax Number :
Provider Business Practice Location Address
First Line : 1000 BLYTHE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5812
Country : US
Telephone Number : 704-355-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 06/04/2026

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