Provider Demographics
NPI:1902086523
Name:TRACER, SAMUEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:TRACER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 MANCHESTER AVE
Mailing Address - Street 2:# 208
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4938
Mailing Address - Country:US
Mailing Address - Phone:760-436-3216
Mailing Address - Fax:858-350-0828
Practice Address - Street 1:4401 MANCHESTER AVE
Practice Address - Street 2:# 208
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4938
Practice Address - Country:US
Practice Address - Phone:760-436-3216
Practice Address - Fax:858-350-0828
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 77001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical