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General NPI Number Information
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NPI Number | 1467390781
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Entity Type | Individual
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Provider Name | TRACEY IRENE MACCIA ITDS
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Gender | Female
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 535 SW BUTLER AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-8738
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Country | US
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Telephone | 848-224-9181
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Fax |
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Provider Business Mailing Address
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Address Line | 20078 SW MATERA WAY
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1736
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Country | US
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Telephone | 908-910-1340
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State | FL
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