Healthcare Provider Details

I. General information

NPI: 1922355767
Provider Name (Legal Business Name): TRACY M. PRYCE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2012
Last Update Date: 08/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CROMWELL BRIDGE RD STE 212
BALTIMORE MD
21286-3330
US

IV. Provider business mailing address

1001 CROMWELL BRIDGE RD STE 212
BALTIMORE MD
21286-3330
US

V. Phone/Fax

Practice location:
  • Phone: 443-610-4074
  • Fax:
Mailing address:
  • Phone: 443-610-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16325
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: