Healthcare Provider Details

I. General information

NPI: 1336074392
Provider Name (Legal Business Name): TRACY A KING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MULBERRY ST
RIDGEFIELD CT
06877-3706
US

IV. Provider business mailing address

32 MULBERRY ST
RIDGEFIELD CT
06877-3706
US

V. Phone/Fax

Practice location:
  • Phone: 914-589-6755
  • Fax: 914-763-9597
Mailing address:
  • Phone: 914-589-6755
  • Fax: 914-763-9597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number038661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: