Healthcare Provider Details

I. General information

NPI: 1629383591
Provider Name (Legal Business Name): TRACY ANN DAGESSE MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 MAIN RD
TIVERTON RI
02878-1126
US

IV. Provider business mailing address

92 MAIN RD
TIVERTON RI
02878-1126
US

V. Phone/Fax

Practice location:
  • Phone: 401-835-1810
  • Fax: 401-425-3131
Mailing address:
  • Phone: 401-835-1810
  • Fax: 401-425-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02089
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: