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NPI Code Detail

MEDICARE: MRS. TRACY E OLEVANO MS ED.

MEDICARE: MRS. TRACY E OLEVANO MS ED.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1083226674
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACY E OLEVANO MS ED.
Provider Business Mailing Address
First Line : 18 BROAD ST
Second Line :
City : JOHNSON CITY
State : NY
Zip : 13790-2198
Country : US
Telephone Number : 607-798-7117
Fax Number : 607-798-0074
Provider Business Practice Location Address
First Line : 18 BROAD ST
Second Line :
City : JOHNSON CITY
State : NY
Zip : 13790-2198
Country : US
Telephone Number : 607-798-7117
Fax Number : 607-798-0074
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2020
Last Update Date : 08/17/2020

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