Healthcare Provider Details

I. General information

NPI: 1689456428
Provider Name (Legal Business Name): TRACY WHITE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 MARION ST
INDIAN HARBOUR BEACH FL
32937-4147
US

IV. Provider business mailing address

278 MARION ST
INDIAN HARBOUR BEACH FL
32937-4147
US

V. Phone/Fax

Practice location:
  • Phone: 985-718-8051
  • Fax:
Mailing address:
  • Phone: 985-718-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26395
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: