MEDICARE: MS. TRACIE MEYERS MSW

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	44SC05440300	NJ

General Provider Information

NPI Number	:	1316971914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACIE MEYERS MSW

Provider Business Mailing Address
First Line	:	100 MAPLE ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304
Country	:	US
Telephone Number	:	201-450-2522
Fax Number	:

Provider Business Practice Location Address
First Line	:	492 COMMUNIPAW AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-2939
Country	:	US
Telephone Number	:	800-994-6242
Fax Number	:	800-994-6242

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/26/2022

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