Provider Demographics
NPI:1184933509
Name:LEVENE, TRACIE
Entity type:Individual
Prefix:MISS
First Name:TRACIE
Middle Name:
Last Name:LEVENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2946
Mailing Address - Country:US
Mailing Address - Phone:617-797-1309
Mailing Address - Fax:
Practice Address - Street 1:500 NORTH MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368
Practice Address - Country:US
Practice Address - Phone:781-885-7252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator