Healthcare Provider Details

I. General information

NPI: 1902166804
Provider Name (Legal Business Name): TRACY WALSH MA, LPC, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MANTOLOKING RD STE C
BRICK NJ
08723-5741
US

IV. Provider business mailing address

321 MANTOLOKING RD STE 2C
BRICK NJ
08723-5741
US

V. Phone/Fax

Practice location:
  • Phone: 848-333-9570
  • Fax:
Mailing address:
  • Phone: 848-333-9570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number37LC00178400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: