Provider Demographics
NPI:1427334184
Name:WEANT, TRACY NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:NICOLE
Last Name:WEANT
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 1:421 E MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2012
Mailing Address - Country:US
Mailing Address - Phone:267-973-8233
Mailing Address - Fax:
Practice Address - Street 1:421 E MONTANA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2012
Practice Address - Country:US
Practice Address - Phone:267-973-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0151801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical