MEDICARE: MS. TRACY L. FREEMAN 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	1041C0700X	Clinical Social Worker	006440	CT

General Provider Information

NPI Number	:	1073791281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY L. FREEMAN LCSW

Provider Business Mailing Address
First Line	:	5020 VINESIA DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-8035
Country	:	US
Telephone Number	:	860-620-7197
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 VINESIA DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-8035
Country	:	US
Telephone Number	:	860-620-7197
Fax Number	:

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

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	05/06/2025

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