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1528307725 NPI number — TRACY ALEXANDRA POLLACK PSYD

NPI Number: 1528307725
Health Care Provider/Practitioner: TRACY ALEXANDRA POLLACK PSYD

Information about “1528307725” NPI (TRACY ALEXANDRA POLLACK PSYD) exists in 1528307725 in HTML format HTML  |  1528307725 in plain Text format TXT  |  1528307725 in PDF (Portable Document Format) PDF  |  1528307725 in an XML format XML  formats.

NPI Number : 1528307725 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528307725",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POLLACK",
    "FirstName": "TRACY",
    "MiddleName": "ALEXANDRA",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PSYD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BERK",
    "OtherFirstName": "TRACY",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PSYD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "6399 WILSHIRE BLVD",
    "SecondLineMailingAddress": "SUITE 312",
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90048-5703",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-845-6847",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6399 WILSHIRE BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 312",
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90048-5703",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-845-6847",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/07/2013",
    "LastUpdateDate": "05/02/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "24769",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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