Provider Demographics
NPI:1316482102
Name:VEDDER, TRACY LYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYN
Last Name:VEDDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:LYN
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3161 FRENCH RD
Mailing Address - Street 2:PO BOX 279
Mailing Address - City:YORKSHIRE
Mailing Address - State:NY
Mailing Address - Zip Code:14173-8005
Mailing Address - Country:US
Mailing Address - Phone:716-353-2832
Mailing Address - Fax:
Practice Address - Street 1:987 R C HOAG DR
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-1365
Practice Address - Country:US
Practice Address - Phone:716-945-9001
Practice Address - Fax:716-945-0790
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084310-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical