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Individual
TRACY LEE DIVELY SCHULDEN
Active
Individual
TRACY LEE DIVELY SCHULDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
07829
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
198041000
MAGELLAN BEHAVIORAL HEALT
MD
05
—
212150600Q
—
MD
01
—
54688502
MD RENDERING NUMBER
MD
01
—
65080
VALUE OPTIONS
MD
01
—
KC29UN
CAREFIRST BC/BS
MD
01
—
T5140008
REGIONAL BLUE CHOICE
—
Enumeration date
11/21/2005
Last updated
10/27/2011
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