Healthcare Provider Details

I. General information

NPI: 1659985158
Provider Name (Legal Business Name): TRACY HART CRPA-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 STATE HIGHWAY 310 STE 1
CANTON NY
13617-1493
US

IV. Provider business mailing address

80 STATE HIGHWAY 310 STE 1
CANTON NY
13617-1493
US

V. Phone/Fax

Practice location:
  • Phone: 315-386-2189
  • Fax: 315-386-2435
Mailing address:
  • Phone: 315-386-2189
  • Fax: 315-386-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number40131
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: