Healthcare Provider Details

I. General information

NPI: 1649570300
Provider Name (Legal Business Name): TRACEY DELIENNE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST STE 409
BROOKLYN NY
11242-1134
US

IV. Provider business mailing address

26 COURT ST STE 409
BROOKLYN NY
11242-1134
US

V. Phone/Fax

Practice location:
  • Phone: 646-759-2641
  • Fax:
Mailing address:
  • Phone: 646-759-2641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: