Healthcare Provider Details

I. General information

NPI: 1194948828
Provider Name (Legal Business Name): TRACEY ANN BARSOTTI B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WOODLANE RD
WESTAMPTON NJ
08060-3832
US

IV. Provider business mailing address

51 ANDY SNYDER RD
DEPTFORD NJ
08096-2858
US

V. Phone/Fax

Practice location:
  • Phone: 856-428-4357
  • Fax:
Mailing address:
  • Phone: 609-970-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: