TRACY MICKELSON (NPI# 1639785033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639785033 |
| Entity Type | Individual |
| Full Name | TRACY MICKELSON |
| Credential | CASAC |
| Practice Address |
1149 Sullivan St Ste B Elmira NY 14901-1670 |
| Practice Telephone | 6077337661 |
| Practice Fax Number | 6077337675 |
| Mailing Telephone | 6077337661 |
| Mailing Fax Number | 6077337675 |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2020-09-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
NY | Behavioral Health & Social Service Providers |
| Street Address |
1149 SULLIVAN ST STE B |
| City | ELMIRA |
| State | NY |
| Zip Code | 14901-1670 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215587753 | Michelle Wright | Counselor | 1149 Sullivan St Ste B, Elmira, NY 14901-1670 | 2019-09-17 |
| 1811596158 | Cynthia Lynn Toth | Counselor | 1149 Sullivan St Ste B, Elmira, NY 14901-1670 | 2020-10-19 |
| 1982217659 | Matthew Alexander Pitcher | Social Worker | 1149 Sullivan St Ste B, Elmira, NY 14901-1670 | 2020-08-24 |
| 1093355851 | Jacklyn Egan | Peer Specialist | 1149 Sullivan St Ste B, Elmira, NY 14901-1670 | 2020-01-09 |
| 1902446032 | Jean A Robbins | Registered Nurse | 1149 Sullivan St Ste B, Elmira, NY 14901-1670 | 2020-01-07 |
| 1902445273 | Larry D. Bartlett Jr. | Peer Specialist | 1149 Sullivan St Ste B, Elmira, NY 14901-1670 | 2020-01-03 |
| 1780222869 | Etosha Blank | Counselor | 1149 Sullivan St Ste B, Elmira, NY 14901-1670 | 2019-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447818182 | Davida Reane Moss | Case Manager/Care Coordinator | 310 Pensyvania Avenue, Elmira, NY 14901 | 2019-05-29 |
| 1316504889 | Jessica Leigh Badilla | Counselor | 1013 Water St, Elmira, NY 14901 | 2019-05-21 |
| 1427508811 | Cynthia Ann Sullivan | Counselor | 1019 E. Water Street, Elmira, NY 14901 | 2016-10-10 |
| 1508313362 | Kim Burlew | Case Manager/Care Coordinator | 1019 W. Water Street Family Services of Chemung County, Elmire, NY 14901 | 2016-09-08 |
| 1396195095 | State of New York Comptrollers Office | Clinic/Center | 164 Sullivan Street, Elmira, NY 14901 | 2016-06-14 |
| 1285089581 | Tasha R Miller | Licensed Practical Nurse | 426 Woodawn Ct, Elmira, NY 14901 | 2016-04-25 |
| 1750628111 | Kelly E Bartle-bush | Social Worker | 711 Sullivan St., Elmira, NY 14901 | 2013-01-04 |
| 1144594946 | Brian Mustico | Occupational Therapist | 512 West Clinton Street, Apartment B, Elmira, NY 14901 | 2012-02-27 |
| 1063780880 | Deidre Ann Callaghan | Physical Therapy Assistant | 555 St.josephs Blvd, Elmira, NY 14901 | 2011-12-07 |
| 1972889467 | Arnot Health | General Acute Care Hospital | 1 St.joseph's Blvd., Elmira, NY 14901 | 2011-10-27 |
| Find all providers in zip 14901 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770793341 | Economic Opportunity Program | Counselor | 350 Baldwin St., Elmira, NY 14901 | 2007-05-23 |
| 1558720375 | James Dempsey | Counselor | 1149 Sullivan St, Elmira, NY 14901-1670 | 2016-02-22 |
| 1386043222 | Dean Kellerhouse | Counselor | 150 Lake St, 2nd Floor, Elmira, NY 14901-3401 | 2014-08-16 |
| 1235576513 | Catherine Elizabeth Basu | Counselor | 150 Lake St, Elmira, NY 14901-3401 | 2013-05-28 |
| 1922442052 | Jeffrey Caris | Counselor | 150 Lake St, Elmira, NY 14901-3401 | 2013-04-19 |
| 1013183730 | Sarah Belle Secor | Counselor | 1019 E Water St, Elmira, NY 14901-3332 | 2008-05-02 |
| 1427234699 | Gregory Hepburn | Counselor | 100 N Main St, Elmira, NY 14901-2901 | 2008-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578622 | Roberto Javier Torres | Counselor | 115 Angelacrest Ln, West Seneca, NY 14224-3819 | 2020-11-05 |
| 1386245595 | Liliana Maria Calle | Counselor | 1510 Waters Pl Fl 2, Bronx, NY 10461-2700 | 2020-11-04 |
| 1245831528 | Multi Assistance Resource Centers Inc. | Counselor | 509 Willis Ave Fl 4, Bronx, NY 10455-4001 | 2020-11-04 |
| 1952902371 | Brandon Chevere | Counselor | 175 Remsen St Fl 9, Brooklyn, NY 11201-4333 | 2020-11-03 |
| 1619577541 | Josselyn D Carias-rodriguez | Counselor | 90 Cherry Ln, Hicksville, NY 11801-6232 | 2020-10-29 |
| 1275133688 | Carol Hunt | Counselor | 76 Humboldt Pkwy, Buffalo, NY 14214-2605 | 2020-10-27 |
| 1598363806 | Anabel Lago-pedrick | Counselor | 539 County Road 40, Maplecrest, NY 12454-1245 | 2020-10-09 |
| 1386241511 | Kelly Jensen | Counselor | 255 Delaware Ave Ste 3000, Buffalo, NY 14202-2016 | 2020-10-01 |
| 1538776091 | James Mcrae | Counselor | 100 N Portland Ave Rm B228, Brooklyn, NY 11205-2005 | 2020-09-29 |
| 1215544036 | Jeanette Malpica-oskowitz | Counselor | 100 N Portland Ave # B217, Brooklyn, NY 11205-2005 | 2020-09-25 |
| Find all providers with the same taxonomy | ||||
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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.