TRACY ELAINE GUSTAFSON (NPI# 1093230369) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093230369 |
| Entity Type | Individual |
| Full Name | TRACY ELAINE GUSTAFSON |
| Credential | MA |
| Practice Address |
160 Beechwood Ave Pawtucket RI 02860-5402 |
| Mailing Address |
249 Roosevelt Ave Pawtucket RI 02860-2134 |
| Practice Telephone | 4017248400 |
| Practice Fax Number | 4017248488 |
| Mailing Telephone | 4017248400 |
| Mailing Fax Number | 4017248488 |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2017-08-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295035863 | Tracy Lee Gustafson | Pediatrics | 151 Rainbow Dr, Apt #5152, Livingston, TX 77399-1571 | 2010-10-28 |
| 1386854735 | Tracy Gustafson | Physical Therapist | 203 Whetstone Mls, Dayville, CT 06241-1832 | 2007-05-23 |
| 1508832056 | Tracy Michelle Gustafson | Social Worker | 1803 Whites Rd, Suite 5, Kalamazoo, MI 49008-2883 | 2006-02-24 |
| 1295277291 | Tracy Gustafson | Registered Nurse | 10203 E Mcdowell Mountain Ranch Rd, Scottsdale, AZ 85255-8600 | 2016-11-08 |
| Street Address |
160 BEECHWOOD AVE |
| City | PAWTUCKET |
| State | RI |
| Zip Code | 02860-5402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992772438 | Leah Anne Berg | Social Worker | 160 Beechwood Ave, Pawtucket, RI 02860-3414 | 2006-03-03 |
| 1548752090 | Lindsey Whitney | Marriage & Family Therapist | 160 Beechwood Ave, Pawtucket, RI 02860-5402 | 2018-05-31 |
| 1790284792 | Jan Meredith Jackson | Counselor | 160 Beechwood Ave, Pawtucket, RI 02860-5402 | 2018-02-05 |
| 1710402193 | Brittannie Elspeth Moroz | Counselor | 160 Beechwood Ave, Pawtucket, RI 02860-5402 | 2017-08-07 |
| 1851826531 | Grace Moore | Social Worker | 160 Beechwood Ave, Pawtucket, RI 02860-5402 | 2017-05-01 |
| 1922545011 | Madibet Gomez | Counselor | 160 Beechwood Ave, Pawtucket, RI 02860-5402 | 2017-01-26 |
| 1578005625 | Michael Macedo | Social Worker | 160 Beechwood Ave, Pawtucket, RI 02860-5402 | 2016-11-07 |
| 1003273020 | John Walker | Counselor | 160 Beechwood Ave, Pawtucket, RI 02860-5402 | 2016-01-21 |
| 1376916940 | Judelysse Gomez | Counselor | 160 Beechwood Ave, Pawtucket, RI 02860-5402 | 2015-11-04 |
| 1215316005 | Sando Moore | Counselor | 160 Beechwood Ave, Pawtucket, RI 02860-5402 | 2015-05-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972096923 | Lmb Medical LLC | Internal Medicine | 127 School St, Pawtucket, RI 02860 | 2018-06-13 |
| 1215420435 | Tyla Jackson | Behavior Technician | 70 Wood St Apt 22, Pawtucket, RI 02860 | 2018-06-12 |
| 1376048637 | Michael A Iadevaia | Family Medicine | 111 Brewster St Fl 3, Pawtucket, RI 02860 | 2018-03-28 |
| 1730690488 | Anthony Edwin Ramicone | Physician Assistant | 407 East Ave Ste 120, Pawtucket, RI 02860 | 2017-10-21 |
| 1669991352 | Kathleen K. Kroessler, Md; Neurology & Acupuncture, Inc. PC | Clinic/Center | 407 East Ave; Suite 110, Pawtucket, RI 02860 | 2017-09-13 |
| 1841716230 | Ri Alternative Academy Management, LLC | Local Education Agency (LEA) | 249 Roosevelt Avenue, Pawtucket, RI 02860 | 2017-08-17 |
| 1396265724 | Hannah R Stoops | Family Medicine | 111 Brewster St Fcc A, Pawtucket, RI 02860 | 2017-06-27 |
| 1427578400 | Shaun Michael Flynn | Family Medicine | 111 Brewster St, Fcc A, Pawtucket, RI 02860 | 2017-06-21 |
| 1073051843 | Laura Jane Amaral | Counselor | 750 East Ave Unit 1e, Pawtucket, RI 02860 | 2017-02-01 |
| 1063862027 | Stephanie Shoppell | Counselor | 105 Bacon Street, Pawtucket, RI 02860 | 2016-06-20 |
| Find all providers in zip 02860 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346876810 | Isabel A Miranda | Counselor | 315 East Ave Apt 3, Pawtucket, RI 02860-3854 | 2020-03-17 |
| 1184184228 | Claudia Dorego | Counselor | 125 Goff Ave Unit 3301, Pawtucket, RI 02860-2997 | 2019-03-24 |
| 1174090104 | Crystal Nico | Counselor | 184 School St, Pawtucket, RI 02860-5322 | 2018-10-29 |
| 1558893081 | Alicia Paduan | Counselor | 249 Roosevelt Ave Suite 205, Pawtucket, RI 02860-2134 | 2017-04-03 |
| 1114379914 | Kelly Louise Cunningham | Counselor | 626 Central Ave Apt 3, Pawtucket, RI 02861-1958 | 2016-07-06 |
| 1063862027 | Stephanie Shoppell | Counselor | 105 Bacon Street, Pawtucket, RI 02860 | 2016-06-20 |
| 1558759290 | Amy Moreira | Counselor | 750 East Ave Ste Le, Pawtucket, RI 02860-6245 | 2015-01-05 |
| 1881016707 | Ariadna Yadira Benitez | Counselor | 296 Parkview Dr Apt 8, Pawtucket, RI 02861-3963 | 2014-01-12 |
| 1104255264 | Michelle Kay Crossley | Counselor | 750 East Ave Ste 1b, Pawtucket, RI 02860-6165 | 2013-11-08 |
| 1578819082 | Niki M Best | Counselor | 100 Lafayette St Ste 108, Pawtucket, RI 02860-6008 | 2012-08-02 |
| Find all providers in PAWTUCKET | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.