MEDICARE: DR. TRACY CARTER 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
2	1041C0700X	Clinical Social Worker	094903	NY

General Provider Information

NPI Number	:	1457000424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY CARTER LCSW

Provider Business Mailing Address
First Line	:	522 E 96TH ST APT 2R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-2409
Country	:	US
Telephone Number	:	347-792-3329
Fax Number	:

Provider Business Practice Location Address
First Line	:	399 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2706
Country	:	US
Telephone Number	:	646-832-1876
Fax Number	:

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

Provider Enumeration Date	:	03/18/2022
Last Update Date	:	02/12/2023

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