Active NPI
Tracy Young, LICSW
- Clinical Social Worker
- Providence, RI
National Provider Identifier
1811294440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ISW00482
- Practice address
- 1 Richmond Square
350W
Providence, RI 02906-5165 - Phone
- (401) 227-0372
- Fax
- (877) 455-9466
- NPI assigned
- Feb 17, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 007543 | CT | |
| Clinical Social Worker | 1041C0700X | LICSW127069 | MA | |
| Clinical Social Worker | 1041C0700X | TPSW4022 | FL | |
| Clinical Social Worker | 1041C0700X | ISW00482 | RI | Primary |
Addresses
Primary practice location
1 Richmond Square
350W
Providence, RI 02906-5165
Mailing address
1 Richmond Square
350W
Providence, RI 02906-5165
Phone (401) 227-0372
Other names 1
- Ms. Tracy E Jennerwein
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TPSW4022 | FL | MD | Clinical Social Worker |
| LICSW127069 | MA | MD | Clinical Social Worker |
| ISW00482 | RI | MD | Clinical Social Worker |
| 007543 | CT | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737504000000",
"number": "1811294440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 RICHMOND SQUARE",
"address_2": "350W",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029065165",
"telephone_number": "401-227-0372",
"fax_number": "877-455-9466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 RICHMOND SQUARE",
"address_2": "350W",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029065165",
"telephone_number": "401-227-0372",
"fax_number": "877-455-9466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "TRACY",
"name_prefix": "Ms.",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-17",
"last_updated": "2025-01-22",
"certification_date": "2025-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "007543",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "LICSW127069",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "TPSW4022",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "RI",
"license": "ISW00482",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TRACY",
"last_name": "JENNERWEIN",
"middle_name": "E",
"prefix": "MS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.