MEDICARE: TRACY ROSARIO CHW, CDCA

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	172V00000X	Community Health Worker	002963	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	186813	OH

General Provider Information

NPI Number	:	1518812098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY ROSARIO CHW, CDCA

Provider Business Mailing Address
First Line	:	6314 SPRINGWOOD RD
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-3213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6314 SPRINGWOOD RD
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-3213
Country	:	US
Telephone Number	:	216-527-7119
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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