=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568744324
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACY L EGGER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2011
-----------------------------------------------------
Last Update Date | 09/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 KREAMER ST
-----------------------------------------------------
City | BELLPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11713-2337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-730-1770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 SHERBROOK CT
-----------------------------------------------------
City | SHIRLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11967-4425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-772-2252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 01217716
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------