MEDICARE: DR. TRACY MALLETT PSYD

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
1	106H00000X	Marriage & Family Therapist	MT2077	FL
2	103T00000X	Psychologist	PY7881	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z090E	OTHER	FL	BCBS NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417054990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY MALLETT PSYD

Provider Business Mailing Address
First Line	:	4451 SW 95TH AVE
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-2419
Country	:	US
Telephone Number	:	954-483-1254
Fax Number	:

Provider Business Practice Location Address
First Line	:	8201 PETERS RD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3265
Country	:	US
Telephone Number	:	954-665-4115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	02/11/2024

Similar Medicare Providers

1659351898 — DR. LEAH ELAINE OLSHEIN PSY.D., LMFT
Practice Location Address:

8201 PETERS RD , # 1000
PLANTATION, FL
33324-3265

Practice Phone: 305-926-5044
Practice Fax: 954-315-0240

1639254147 — DR. ROBERT FITZGERALD VASSALL M.D.
Practice Location Address:

8201 PETERS RD , SUITE 1000
PLANTATION, FL
33324-3265

Practice Phone: 954-447-9938
Practice Fax: 954-447-9431

1518253798 — LINDA LEVASSEUR LMHC
Practice Location Address:

8201 PETERS RD , SUITE 1000
PLANTATION, FL
33324-3265

Practice Phone: 954-479-2767
Practice Fax:

1326428814 — FENIX COUNSELING CENTER, INC
Practice Location Address:

8201 PETERS RD , SUITE 1000
PLANTATION, FL
33324-3265

Practice Phone: 954-916-2618
Practice Fax:

1437526530 — ILQ WLLENESS
Practice Location Address:

8201 PETERS RD , C/O MPG
PLANTATION, FL
33324-3265

Practice Phone: 786-520-5274
Practice Fax:

1093183469 — THE ATHLETE'S CLINIC, PLLC
Practice Location Address:

8201 PETERS RD , SUITE 1000
PLANTATION, FL
33324-3265

Practice Phone: 954-774-8784
Practice Fax:

Directions to “ DR. TRACY MALLETT PSYD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.