Tracey Summerville, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

095441 Issued in NY

Practice address

858 E 23Rd St
Brooklyn, NY 11210-2820

Phone

(917) 808-4800

NPI assigned

Sep 9, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Tracey O'Connell Former name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: No
• 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

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

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1538537410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 E 7TH ST",
            "address_2": "APT. 3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100038011",
            "telephone_number": "914-589-7904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "858 E 23RD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112102820",
            "telephone_number": "917-808-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERVILLE",
        "first_name": "TRACEY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-09",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "095441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEY",
            "last_name": "O'CONNELL",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Corrina D. Summers I
• Lionel Summers
• Rebecca C Summers, M.D.
• Nicholas Summerson
• Thomas Summerville
• Summit Estimates LLC
• Summit Home Health Care
• Sumner Place Medical PC
• Sumner Place PT PC
• Sumner Speech PC

• Social Worker in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; 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.