Healthcare Provider Details

I. General information

NPI: 1902486772
Provider Name (Legal Business Name): TRACEY LYNN CLINGO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 W AMES CT
PLAINVIEW NY
11803-2304
US

IV. Provider business mailing address

151 FERNCROFT RD
MINEOLA NY
11501-1806
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-6111
  • Fax:
Mailing address:
  • Phone: 516-661-6499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111197
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: