Provider Demographics
NPI:1063509552
Name:LUNNEY, TRACY A (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:A
Last Name:LUNNEY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1121
Mailing Address - Country:US
Mailing Address - Phone:315-449-0562
Mailing Address - Fax:315-446-7521
Practice Address - Street 1:7030 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1121
Practice Address - Country:US
Practice Address - Phone:315-449-0562
Practice Address - Fax:315-446-7521
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040709-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health