Provider Demographics
NPI:1144643974
Name:GARRISON, TRACY (CASAC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:GARRISON
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1539
Mailing Address - Country:US
Mailing Address - Phone:716-439-4839
Mailing Address - Fax:
Practice Address - Street 1:262 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1539
Practice Address - Country:US
Practice Address - Phone:716-449-4839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16880101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor