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General NPI Number Information
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NPI Number | 1295027217
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Entity Type | Individual
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Provider Name | TRACI LEE PHILLIPS-PERKINS LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 453 DIXON RD BLDG. 3 STE. 8
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City | QUEENSBURY
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State | NY
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Zip | 12804-1949
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Country | US
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Telephone | 518-420-7466
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Fax | 518-745-5731
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Provider Business Mailing Address
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Address Line | PO BOX 4176
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City | QUEENSBURY
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State | NY
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Zip | 12804-0176
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Country | US
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Telephone | 518-420-7466
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R073014-1
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License Number State | NY
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