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General NPI Number Information
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NPI Number | 1174391304
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Entity Type | Individual
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Provider Name | DIANE H TRACEY
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Gender | Female
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 30 E 20TH ST STE 5F
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City | NEW YORK
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State | NY
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Zip | 10003-1310
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Country | US
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Telephone | 908-240-9536
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Fax |
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Provider Business Mailing Address
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Address Line | 120 SHERMAN AVE APT 3A
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City | JERSEY CITY
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State | NJ
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Zip | 07307-2135
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Country | US
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Telephone | 908-240-9536
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Fax |
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 001182-01
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License Number State | NY
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