Kristin Nicole Tracy, LISW-SUPV

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I1440505-SUPV Issued in OH

Practice address

8224 Mentor Ave Ste 208
Mentor, OH 44060-5743

Phone

(440) 392-2222

NPI assigned

May 23, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, OH

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1073041935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8224 MENTOR AVE STE 208",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440605743",
            "telephone_number": "440-392-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8224 MENTOR AVE STE 208",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440605743",
            "telephone_number": "440-392-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRACY",
        "first_name": "KRISTIN",
        "middle_name": "NICOLE",
        "credential": "LISW-SUPV",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I1440505-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Tighe
• Erika Timmons
• Mirela Tomic
• Jessie S Torres, CDCA, QMHS
• Karmen Torres
• Hannah Oberle Tradowsky, LPCC
• Brandon Pedro Tramble, LPC
• Rachel Tramonte
• Dana Ellen Trayter
• Christine Treadway, RPH

• Clinical Social Worker in Mentor, OH
• Providers in Mentor, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.