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General NPI Number Information
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NPI Number | 1710408059
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Entity Type | Individual
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Provider Name | TRACI M MCCOMISKEY CD, CCE, CCHW, PMH-C
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Gender | Female
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 15 CROSSLEY CT
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City | NIANTIC
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State | CT
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Zip | 06357-2342
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Country | US
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Telephone | 860-867-7541
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Fax | 860-867-7541
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Provider Business Mailing Address
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Address Line | 15 CROSSLEY CT
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City | NIANTIC
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State | CT
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Zip | 06357-2342
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Country | US
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Telephone | 860-867-7541
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 188
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number | 1
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License Number State | CT
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