Healthcare Provider Details

I. General information

NPI: 1316971914
Provider Name (Legal Business Name): TRACIE MEYERS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACIE RENEE GRIMSLEY MSW

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 COMMUNIPAW AVE
JERSEY CITY NJ
07304-2939
US

IV. Provider business mailing address

100 MAPLE ST
JERSEY CITY NJ
07304
US

V. Phone/Fax

Practice location:
  • Phone: 800-994-6242
  • Fax: 800-994-6242
Mailing address:
  • Phone: 201-450-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05440300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: