Individual
DR. TRACY MALLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
8201 PETERS RD, PLANTATION, FL 33324-3265
(954) 665-4115
Mailing address
4451 SW 95TH AVE, COOPER CITY, FL 33328-2419
(954) 483-1254
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY7881
FL
106H00000X
Marriage & Family Therapist
MT2077
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z090E
BCBS NUMBER
FL
Enumeration date
09/19/2006
Last updated
02/11/2024
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