Provider Demographics
NPI:1962427328
Name:BARNES, TRACEY ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:ANNE
Last Name:BARNES
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 1:21 LAUREL AVE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1469
Mailing Address - Country:US
Mailing Address - Phone:845-458-4757
Mailing Address - Fax:845-458-4559
Practice Address - Street 1:21 LAUREL AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1469
Practice Address - Country:US
Practice Address - Phone:845-458-4757
Practice Address - Fax:845-458-4559
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071287-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical