Provider Demographics
NPI:1174394084
Name:DOS SANTOS ROCHA, TRACY (LPC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:DOS SANTOS ROCHA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1119
Mailing Address - Country:US
Mailing Address - Phone:848-667-1148
Mailing Address - Fax:
Practice Address - Street 1:1387 CHEWS LANDING RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-2760
Practice Address - Country:US
Practice Address - Phone:855-278-7728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00997600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional