Healthcare Provider Details

I. General information

NPI: 1174289912
Provider Name (Legal Business Name): TRACITY GORDON JAMES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 ROUTE 18 STE 304
EAST BRUNSWICK NJ
08816-1407
US

IV. Provider business mailing address

265 E 28TH ST
PATERSON NJ
07514-1723
US

V. Phone/Fax

Practice location:
  • Phone: 732-354-0623
  • Fax: 732-354-0358
Mailing address:
  • Phone: 973-563-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00419000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC06647100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: