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Individual
TRACEY BASSETT-TANZ
Active
Individual
TRACEY BASSETT-TANZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
018366
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285628552
OTHER
—
Enumeration date
03/23/2007
Last updated
02/09/2022
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