| Doctor Name: | TRACY WROCKLAGE |
| NPI Number: | 1902166804 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | 37LC00178400 |
| Business Practice Address: | 500 Main St Bldg 2 Lanoka Harbor, NJ - 087342228 |
| Business Phone Number: | 6099718989 |
| Business Fax Number: | 6092423207 |
| Mailing Address: | 500 Main St Bldg 2, LANOKA HARBOR |
| State: | NJ |
| Postal Code: | 087342228 |
| Phone Number: | 6099718989 |
| Fax Number: | 6092423207 |
| NPI Enumeration Date: | 05/24/2012 |
| NPI Last Update Date: | 05/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | 37LC00178400 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |