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General NPI Number Information
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NPI Number | 1508486440
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Entity Type | Individual
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Provider Name | TRACEY SHANIECE ROSS LCSW, LCADC
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Gender | Female
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 10/11/2025
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Provider Practice Location Address
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Address Line | 333B ROUTE 46 W STE 205
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City | FAIRFIELD
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State | NJ
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Zip | 07004-2463
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Country | US
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Telephone | 201-873-5827
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Fax |
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Provider Business Mailing Address
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Address Line | 355 OLD TARRYTOWN RD APT 408
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City | WHITE PLAINS
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State | NY
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Zip | 10603-5624
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Country | US
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Telephone | 201-873-5827
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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 | 44SC06008600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00360500
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License Number State | NJ
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