Provider Demographics
NPI:1285696799
Name:AUDET, TRACY ALLEN (LCSW LADC)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ALLEN
Last Name:AUDET
Suffix:
Gender:F
Credentials:LCSW LADC
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:A
Other - Last Name:WALKER (BRADBURY)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LADC
Mailing Address - Street 1:40 HEATH LN
Mailing Address - Street 2:TRACY AUDET LCSW, LADC
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-3711
Mailing Address - Country:US
Mailing Address - Phone:207-753-0783
Mailing Address - Fax:207-753-0323
Practice Address - Street 1:571 SABATTUS ST STE 7
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-4156
Practice Address - Country:US
Practice Address - Phone:207-753-0783
Practice Address - Fax:207-753-0323
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC63701041C0700X
MELC4081101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME265120099Medicaid
MEBRME0689Medicare ID - Type Unspecified