Provider Demographics
NPI:1053597187
Name:EARLE, TRACY LEE (LCSW)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LEE
Last Name:EARLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:LEE
Other - Last Name:HILDEBRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1009 MAITLAND CENTER COMMONS BLVD
Mailing Address - Street 2:#212
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7270
Mailing Address - Country:US
Mailing Address - Phone:800-840-9528
Mailing Address - Fax:407-540-9552
Practice Address - Street 1:1009 MAITLAND CENTER COMMONS BLVD
Practice Address - Street 2:#212
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7270
Practice Address - Country:US
Practice Address - Phone:800-840-9528
Practice Address - Fax:407-540-9552
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW77781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical