Provider Demographics
NPI:1730884107
Name:DESANTIS, TRACEY (LCSW)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:DESANTIS
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 1:3331 SUMMIT BLVD APT 126
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4327
Mailing Address - Country:US
Mailing Address - Phone:814-636-9141
Mailing Address - Fax:814-646-9141
Practice Address - Street 1:3331 SUMMIT BLVD APT 126
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4327
Practice Address - Country:US
Practice Address - Phone:814-636-9141
Practice Address - Fax:814-646-9141
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0248131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical