Healthcare Provider Details

I. General information

NPI: 1922211903
Provider Name (Legal Business Name): TRACY SMITH L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 NORWICH WESTERLY RD 3-D , BOX 405
NORTH STONINGTON CT
06359-9998
US

IV. Provider business mailing address

PO BOX 405
NORTH STONINGTON CT
06359-0405
US

V. Phone/Fax

Practice location:
  • Phone: 860-303-0383
  • Fax:
Mailing address:
  • Phone: 860-303-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6000
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: