Healthcare Provider Details

I. General information

NPI: 1114199767
Provider Name (Legal Business Name): TRACY L MCCAFFERTY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 DUNDEE RD 1504
NORTHBROOK IL
60062-2727
US

IV. Provider business mailing address

842 WESTERN AVE
NORTHBROOK IL
60062-3449
US

V. Phone/Fax

Practice location:
  • Phone: 847-476-1532
  • Fax: 847-509-1532
Mailing address:
  • Phone: 847-476-1532
  • Fax: 847-509-1532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: