Provider Demographics
NPI:1124294806
Name:SCHROEDER, TRACY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:SCHROEDER
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 1:670 CARNEGIE DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3519
Mailing Address - Country:US
Mailing Address - Phone:909-252-4522
Mailing Address - Fax:
Practice Address - Street 1:670 CARNEGIE DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3519
Practice Address - Country:US
Practice Address - Phone:909-252-4522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA229531041C0700X
CALCS 229531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical