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NPI Code Detail

MEDICARE: TRACEY MUSARRA MARCHESE MSW, LCSW-R

MEDICARE: TRACEY MUSARRA MARCHESE MSW, LCSW-R
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 Worker44SC04400100NJ
21041C0700XClinical Social WorkerR076602NY

General Provider Information

NPI Number : 1821217266
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACEY MUSARRA MARCHESE MSW, LCSW-R
Provider Business Mailing Address
First Line : 161 W BAYARD ST
Second Line : APT. 107
City : SENECA FALLS
State : NY
Zip : 13148-1737
Country : US
Telephone Number : 315-712-4080
Fax Number :
Provider Business Practice Location Address
First Line : 2100 E GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-2249
Country : US
Telephone Number : 315-720-7379
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2007
Last Update Date : 09/30/2010

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