Healthcare Provider Details

I. General information

NPI: 1073523890
Provider Name (Legal Business Name): HEDDIE TRACY TINKER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. HEDDIE VIRGINIA TRACY

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W 34TH ST PENTHOUSE
NEW YORK NY
10001-3006
US

IV. Provider business mailing address

150 W 87TH ST APT 7D
NEW YORK NY
10024-2952
US

V. Phone/Fax

Practice location:
  • Phone: 212-724-8014
  • Fax:
Mailing address:
  • Phone: 212-724-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000801
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000801
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number000801
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number000801
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number000801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: