Healthcare Provider Details

I. General information

NPI: 1417356171
Provider Name (Legal Business Name): TRACY JONES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 SW 37TH AVE
COCONUT GROVE FL
33133-2740
US

IV. Provider business mailing address

17454 SW 108TH CT
MIAMI FL
33157-4002
US

V. Phone/Fax

Practice location:
  • Phone: 305-646-0112
  • Fax:
Mailing address:
  • Phone: 786-245-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: