=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659301448
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACI W PIRRI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 08/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 BARRETT DR SUITE 311-F
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-6641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-368-5921
-----------------------------------------------------
Fax | 919-871-0575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4500 OAKSHYRE WAY
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27616-0701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-368-5921
-----------------------------------------------------
Fax | 919-871-0575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C005156
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------