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General NPI Number Information
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NPI Number | 1760013049
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Entity Type | Individual
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Provider Name | TRACY ANNE HAELEN
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Gender | Female
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 625 PANORAMA TRL
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City | ROCHESTER
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State | NY
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Zip | 14625-2404
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Country | US
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Telephone | 585-737-7825
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Fax |
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Provider Business Mailing Address
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Address Line | 46 LONESOME RD
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City | FAIRPORT
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State | NY
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Zip | 14450-1002
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Country | US
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Telephone | 585-737-7825
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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