1922208537 NPI number — DR. TRACY MARIE NEWBERN LMSW, LISW-S, LCSW

Table of content: DR. TRACY MARIE NEWBERN LMSW, LISW-S, LCSW (NPI 1922208537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922208537 NPI number — DR. TRACY MARIE NEWBERN LMSW, LISW-S, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWBERN
Provider First Name:
TRACY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LMSW, LISW-S, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEWBERN
Provider Other First Name:
TRACY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922208537
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 352024
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43635-2024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-975-9068
Provider Business Mailing Address Fax Number:
855-450-2036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2138 LOXLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43613-5015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-902-2010
Provider Business Practice Location Address Fax Number:
855-450-2036
Provider Enumeration Date:
07/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801074329 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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