=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619823531
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE FAITH TRACY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2026
-----------------------------------------------------
Last Update Date | 03/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6650 BROWNING RD RM U14
-----------------------------------------------------
City | PENNSAUKEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08109-1479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-831-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 610 HAMPSHIRE AVE
-----------------------------------------------------
City | AUDUBON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08106-2206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-904-7935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 44SL06528000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------