Provider Demographics
NPI:1760662662
Name:TRACEY, LAURA (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
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 1:34 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1839
Mailing Address - Country:US
Mailing Address - Phone:303-887-2844
Mailing Address - Fax:
Practice Address - Street 1:7897 CLOVERFIELD CIR
Practice Address - Street 2:SUITE 330
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3050
Practice Address - Country:US
Practice Address - Phone:303-887-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSW 1081041C0700X
FLSW65591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical