MEDICARE: TRACI FORTNER 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	121382	CA

General Provider Information

NPI Number	:	1689964330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI FORTNER LCSW

Provider Business Mailing Address
First Line	:	1045 BIRCH CT
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-7012
Country	:	US
Telephone Number	:	408-425-1267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 BIRCH CT
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-7012
Country	:	US
Telephone Number	:	408-425-1267
Fax Number	:

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

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	03/17/2026

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