MEDICARE: MISS TRACEY JEAN HUFF LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	44SC05409400	NJ

General Provider Information

NPI Number	:	1013215391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TRACEY JEAN HUFF LCSW

Provider Business Mailing Address
First Line	:	45 NORTH BROAD STREET
Second Line	:	SUITE 505
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3822
Country	:	US
Telephone Number	:	201-805-1517
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 NORTH BROAD STREET
Second Line	:	SUITE 505
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3822
Country	:	US
Telephone Number	:	201-805-1517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2011
Last Update Date	:	03/10/2011

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