Healthcare Provider Details

I. General information

NPI: 1013215391
Provider Name (Legal Business Name): TRACEY JEAN HUFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NORTH BROAD STREET SUITE 505
RIDGEWOOD NJ
07450-3822
US

IV. Provider business mailing address

45 NORTH BROAD STREET SUITE 505
RIDGEWOOD NJ
07450-3822
US

V. Phone/Fax

Practice location:
  • Phone: 201-805-1517
  • Fax:
Mailing address:
  • Phone: 201-805-1517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC05409400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: