Healthcare Provider Details

I. General information

NPI: 1568580793
Provider Name (Legal Business Name): TRACEY E NICOLOSI LMHC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 CANAL ST 3RD FLOOR
LAWRENCE MA
01840-1244
US

IV. Provider business mailing address

31 SAWYER ST
METHUEN MA
01844-2241
US

V. Phone/Fax

Practice location:
  • Phone: 978-687-6300
  • Fax: 978-682-4843
Mailing address:
  • Phone: 978-687-6300
  • Fax: 978-682-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number940
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4504
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: