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NPI Code Detail

MEDICARE: TRACY BANE LCSW

MEDICARE: TRACY BANE 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
1305S00000XPoint of Service

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 : 1326605916
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRACY BANE LCSW
Provider Business Mailing Address
First Line : 3201 SHAMROCK ST S STE 103
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32309-3349
Country : US
Telephone Number : 850-894-0061
Fax Number : 850-894-0062
Provider Business Practice Location Address
First Line : 3201 SHAMROCK ST S STE 103
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32309-3349
Country : US
Telephone Number : 850-894-0061
Fax Number : 850-894-0062
Authorized Official
Title or Position : OWNER
Name : TRACY BANE
Credential : LCSW
Telephone Number : 850-894-0061
Provider Enumeration Date : 05/20/2019
Last Update Date : 05/20/2019

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Directions to “TRACY BANE LCSW ” Practice Location

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