Doctor Name: | DR. JOSEPH I. TRACY |
NPI Number: | 1386667905 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | SI 03245 |
Business Practice Address: | 909 Walnut Street Cob, 2nd Floor Philadelphia, PA - 191075509 |
Business Phone Number: | 2159551234 |
Business Fax Number: | 2155036792 |
Mailing Address: | 909 Walnut Street, Cob, 2nd Floor PHILADELPHIA |
State: | PA |
Postal Code: | 191075509 |
Phone Number: | 2159551234 |
Fax Number: | 2155036792 |
NPI Enumeration Date: | 07/25/2006 |
NPI Last Update Date: | 09/08/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | SI 03245 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |