Healthcare Provider Details

I. General information

NPI: 1942534003
Provider Name (Legal Business Name): TRACY A DELESKEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BIRD ST
FOXBORO MA
02035-2338
US

IV. Provider business mailing address

PO BOX 9135
FOXBORO MA
02035-9135
US

V. Phone/Fax

Practice location:
  • Phone: 508-543-8888
  • Fax: 508-543-3692
Mailing address:
  • Phone: 508-543-8888
  • Fax: 508-543-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113904
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: