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General NPI Number Information
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NPI Number | 1164620233
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Entity Type | Individual
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Provider Name | TRACEY UNGAR PHD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 156 5TH AVE SUITE 1208
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City | NEW YORK
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State | NY
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Zip | 10010-7002
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Country | US
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Telephone | 914-391-2968
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Fax | 973-928-5008
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Provider Business Mailing Address
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Address Line | 83 SPRING ST 2 FL
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City | LODI
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State | NJ
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Zip | 07644-3116
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Country | US
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Telephone | 973-928-5008
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Fax | 973-928-5008
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0166271
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License Number State | NY
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