Healthcare Provider Details

I. General information

NPI: 1295427706
Provider Name (Legal Business Name): COLIN TRACEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 DRESHER RD STE 1100
HORSHAM PA
19044-2216
US

IV. Provider business mailing address

715 TWINING RD STE 120
DRESHER PA
19025-1832
US

V. Phone/Fax

Practice location:
  • Phone: 215-254-6000
  • Fax: 215-754-1705
Mailing address:
  • Phone: 215-254-6000
  • Fax: 215-754-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW024202
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23984
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: