Provider Demographics
NPI:1134819006
Name:DANTONE, TRACEY ANN (LSW)
Entity type:Individual
Prefix:MISS
First Name:TRACEY
Middle Name:ANN
Last Name:DANTONE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SUYDAM ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2417
Mailing Address - Country:US
Mailing Address - Phone:732-246-4025
Mailing Address - Fax:732-246-1214
Practice Address - Street 1:320 SUYDAM ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2417
Practice Address - Country:US
Practice Address - Phone:732-246-4025
Practice Address - Fax:732-246-1214
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06617300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)