MEDICARE: TRACY R. DUBRAY 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	CSW-1895	CO

General Provider Information

NPI Number	:	1124309042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY R. DUBRAY LCSW

Provider Business Mailing Address
First Line	:	1775 GLEN DALE DR
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-3015
Country	:	US
Telephone Number	:	303-656-6725
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 GLEN DALE DR
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-3015
Country	:	US
Telephone Number	:	303-656-6725
Fax Number	:

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

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/06/2011

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