Provider Demographics
NPI:1174999551
Name:DOSSICK, TRACIE (LMSW)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:DOSSICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 63RD ST
Mailing Address - Street 2:APT. 7G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7721
Mailing Address - Country:US
Mailing Address - Phone:215-208-6401
Mailing Address - Fax:
Practice Address - Street 1:260 MADISON AVE
Practice Address - Street 2:SUITE 8006
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2401
Practice Address - Country:US
Practice Address - Phone:212-335-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089691104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker