Tracie M Ford, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW21224 Issued in FL

Practice address

3770 Hampton Hills Dr
Lakeland, FL 33810-3867

Phone

(856) 434-3357

NPI assigned

Dec 24, 2019

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1577145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1659910503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3770 HAMPTON HILLS DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338103867",
            "telephone_number": "856-434-3357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3770 HAMPTON HILLS DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338103867",
            "telephone_number": "856-434-3357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORD",
        "first_name": "TRACIE",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-24",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00313600",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW21224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "soulfulhealing@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "2 E Lecato Ave",
            "city": "West Deptford",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080862500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Deldrishia Footman, BEHAVIOR TECHNICIAN
• Mark Andrew Foppe, DO
• Taylor Denise Ford Joseph, DC
• Chloe Ford, NP
• Rachel Magdalene Ford, RBT
• Matthew Joseph Forestiere, M.D.
• Kristen Moore Forgue, MS CCCSLP
• Damaris Yamilet Fornaris Garcell
• Amy J Fort, ARNP
• Dominick Richard Fortunato, BEHAVIOR TECHNICIAN

• All providers in Lakeland, FL
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; 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.