Individual
TRACY ELIZABETH CARMODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LMHC, NCC, CASAC
Contact information
Practice address
112 DEWITT ST, STE 205A, SYRACUSE, NY 13203-2890
(315) 719-7117
Mailing address
112 DEWITT ST, SYRACUSE, NY 13203-2890
(315) 719-7117
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
004833
NY
101YA0400X
Addiction (Substance Use Disorder) Counselor
22841
NY
101YM0800X
Mental Health Counselor
004833
NY
Other
Enumeration date
02/09/2012
Last updated
09/23/2012
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