Healthcare Provider Details

I. General information

NPI: 1124095559
Provider Name (Legal Business Name): TRACY JOAN CASCIO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 W 14TH ST
OAKLAND CA
94607-5031
US

IV. Provider business mailing address

2004 SWAN ST
DANVILLE CA
94506-1142
US

V. Phone/Fax

Practice location:
  • Phone: 510-587-3405
  • Fax: 510-587-3420
Mailing address:
  • Phone: 510-587-3405
  • Fax: 510-587-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS17558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: