Provider Demographics
NPI:1679106884
Name:LEZOTT, TRACY ANN (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:LEZOTT
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 SCRIMSHAW CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6258
Mailing Address - Country:US
Mailing Address - Phone:908-202-3169
Mailing Address - Fax:
Practice Address - Street 1:112 ROUTE 526
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501-2015
Practice Address - Country:US
Practice Address - Phone:732-512-8766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-16
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
44SC058229001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical