Provider Demographics
NPI:1104273580
Name:MCCLOREY, TRACY (LISW-S CDCA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MCCLOREY
Suffix:
Gender:F
Credentials:LISW-S CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-2705
Mailing Address - Country:US
Mailing Address - Phone:513-706-0263
Mailing Address - Fax:513-621-3186
Practice Address - Street 1:401 VINE ST, 3RD FLR.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1922
Practice Address - Country:US
Practice Address - Phone:513-549-3438
Practice Address - Fax:513-621-3186
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH110407101YA0400X
OHI.1302880.SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)