Healthcare Provider Details

I. General information

NPI: 1396034864
Provider Name (Legal Business Name): TRACEY CRANSTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EAST GREEN STREET TOMPKINS COUNTY MENTAL HEALTH SERVICES
ITHACA NY
14850
US

IV. Provider business mailing address

201 EAST GREEN STREET TOMPKINS COUNTY MENTAL HEALTH SERVICES
ITHACA NY
14850
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-6200
  • Fax: 607-274-6316
Mailing address:
  • Phone: 607-274-6200
  • Fax: 607-274-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number605876
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number40-401600
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: