Healthcare Provider Details

I. General information

NPI: 1326372145
Provider Name (Legal Business Name): TRACY HOBBS-JOHNSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FISHER RD
BERLIN VT
05602-9516
US

IV. Provider business mailing address

70 AUSTIN ST
LOWELL MA
01854-4056
US

V. Phone/Fax

Practice location:
  • Phone: 802-479-0014
  • Fax:
Mailing address:
  • Phone: 802-728-4466
  • Fax: 802-728-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2014011908
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1010128236
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0680057753
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: