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NPI Code Detail

MEDICARE: MS. TRACY ELIZABETH PHILLIPS LCSW, ATR

MEDICARE: MS. TRACY ELIZABETH PHILLIPS LCSW, ATR
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
11041C0700XClinical Social WorkerR055230-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2W22701OTHERNYMAGELLEN
3055230A37OTHERNYHEALTH FIRST

General Provider Information

NPI Number : 1578648309
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRACY ELIZABETH PHILLIPS LCSW, ATR
Provider Business Mailing Address
First Line : 811 GREENWOOD AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11218-1311
Country : US
Telephone Number : 718-854-2418
Fax Number :
Provider Business Practice Location Address
First Line : 2795 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-5857
Country : US
Telephone Number : 718-761-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 07/08/2007

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