MEDICARE: TRACY DUTTON

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1942580642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY DUTTON

Provider Business Mailing Address
First Line	:	1129 OLD FORGE RD
Second Line	:
City	:	NEW CASTLE
State	:	DE
Zip	:	19720-5430
Country	:	US
Telephone Number	:	302-221-6679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1129 OLD FORGE RD
Second Line	:
City	:	NEW CASTLE
State	:	DE
Zip	:	19720-5430
Country	:	US
Telephone Number	:	302-221-6679
Fax Number	:

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

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/25/2011

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Directions to “ TRACY DUTTON ” Practice Location

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