Provider Demographics
NPI:1194919654
Name:SARKAR, TRACIE ANNE (NBCCH, MA, MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:ANNE
Last Name:SARKAR
Suffix:
Gender:F
Credentials:NBCCH, MA, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-8007
Mailing Address - Country:US
Mailing Address - Phone:973-575-8787
Mailing Address - Fax:973-575-0178
Practice Address - Street 1:360 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-8007
Practice Address - Country:US
Practice Address - Phone:973-575-8787
Practice Address - Fax:973-575-0178
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053007001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical