Healthcare Provider Details

I. General information

NPI: 1528567757
Provider Name (Legal Business Name): TRACY ERIN PERRY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 MEADS CREEK RD
PAINTED POST NY
14870-9509
US

IV. Provider business mailing address

963 WALNUT ST
ELMIRA NY
14901-1831
US

V. Phone/Fax

Practice location:
  • Phone: 607-962-3100
  • Fax: 607-962-4300
Mailing address:
  • Phone: 607-734-1447
  • Fax: 607-767-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107460-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: