Provider Demographics
NPI:1174128839
Name:TRACEY, MELISSA KATE (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATE
Last Name:TRACEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FOX HILL DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5052
Mailing Address - Country:US
Mailing Address - Phone:973-615-8820
Mailing Address - Fax:
Practice Address - Street 1:13 FOX HILL DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5052
Practice Address - Country:US
Practice Address - Phone:973-615-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05891800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health