| Tracie Preli-derwin, Lcsw, Pllc | |
|
266 Meriden Ave Southington CT 06489-3629 | |
| (860) 414-3200 | |
| (860) 414-3625 |
| Full Name | Tracie Preli-derwin, Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 266 Meriden Ave, Southington, Connecticut |
| Authorized Official Name and Position | Tracie L Preli-derwin (OWNER) |
| Authorized Official Contact | 8604143200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tracie Preli-derwin, Lcsw, Pllc 125 Main Street Po Box 647 Southington CT 06489-9998 Ph: (860) 414-3200 | Tracie Preli-derwin, Lcsw, Pllc 266 Meriden Ave Southington CT 06489-3629 Ph: (860) 414-3200 |
| NPI Number | 1124608054 |
|---|---|
| Provider Enumeration Date | 04/13/2021 |
| Last Update Date | 04/13/2021 |
| Certification Date | 04/07/2021 |
| Medicare PECOS PAC ID | 4688072200 |
|---|---|
| Medicare Enrollment ID | O20211013000712 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124608054 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tracie Preli-derwin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497014344 PECOS PAC ID: 8426213000 Enrollment ID: I20120705000221 |
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