Healthcare Provider Details

I. General information

NPI: 1134240369
Provider Name (Legal Business Name): TRACEY MEYERS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BRANDY ST
BOLTON CT
06043-7602
US

IV. Provider business mailing address

90 BRANDY ST
BOLTON CT
06043-7602
US

V. Phone/Fax

Practice location:
  • Phone: 860-966-4578
  • Fax:
Mailing address:
  • Phone: 860-966-4578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number002195
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002195
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: