Tracey Andersen, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

006769 Issued in NY

Practice address

2855 Depot LN
Cutchogue, NY 11935-1231

Phone

(631) 745-4189

NPI assigned

Jan 14, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1484352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1275079212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 DEPOT LN",
            "city": "CUTCHOGUE",
            "state": "NY",
            "postal_code": "119351231",
            "telephone_number": "631-745-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 DEPOT LN",
            "city": "CUTCHOGUE",
            "state": "NY",
            "postal_code": "119351231",
            "telephone_number": "631-745-4189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 E Main St",
            "address_purpose": "LOCATION",
            "city": "Riverhead",
            "state": "NY",
            "postal_code": "119012680",
            "country_code": "US",
            "telephone_number": "631-745-1834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "TRACEY",
        "name_prefix": "Dr.",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-14",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "006769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Cutchogue, NY
• Providers in Cutchogue, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.