Active NPI
Eva Tracy-Raeder, LICSW
- Clinical Social Worker
- North Adams, MA
National Provider Identifier
1801306949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 120360
- Practice address
- 508 State Road
Greylock Works Studio A5
North Adams, MA 01247 - Phone
- (413) 597-8964
- NPI assigned
- Oct 3, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 120360 | MA | Primary |
Addresses
Primary practice location
508 State Road
Greylock Works Studio A5
North Adams, MA 01247
Mailing address
PO Box 769
Williamstown, MA 01267-0769
Phone (631) 329-4809
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 10, 2020 through Mar 10, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120360 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567641600000",
"number": "1801306949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 769",
"city": "WILLIAMSTOWN",
"state": "MA",
"postal_code": "012670769",
"telephone_number": "631-329-4809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 STATE ROAD",
"address_2": "GREYLOCK WORKS STUDIO A5",
"city": "NORTH ADAMS",
"state": "MA",
"postal_code": "01247",
"telephone_number": "413-597-8964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACY-RAEDER",
"first_name": "EVA",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-03",
"last_updated": "2019-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "120360",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Adams, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.