Healthcare Provider Details

I. General information

NPI: 1205770971
Provider Name (Legal Business Name): TRACY MICHELLE MORAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 UNION ST
MILTON DE
19968-1622
US

IV. Provider business mailing address

312 SEENEYTOWN RD
CLAYTON DE
19938-3248
US

V. Phone/Fax

Practice location:
  • Phone: 301-304-7108
  • Fax: 301-732-7336
Mailing address:
  • Phone: 302-824-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberQ3-0011014
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: