Individual
DR. JOSEPH I. TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
909 WALNUT STREET, COB, 2ND FLOOR, PHILADELPHIA, PA 19107-5509
(215) 955-1234
(215) 503-6792
Mailing address
909 WALNUT STREET, COB, 2ND FLOOR, PHILADELPHIA, PA 19107-5509
(215) 955-1234
(215) 503-6792
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PS-006545-L
PA
103G00000X
Clinical Neuropsychologist
SI 03245
NJ
103TC0700X
Clinical Psychologist
PS-006545-L
PA
103TC0700X
Clinical Psychologist
SI 03245
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017881100002
—
PA
05
—
8109303
—
NJ
Enumeration date
07/25/2006
Last updated
09/08/2014
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