Provider Demographics
NPI:1043373020
Name:GAYESKI, TRACY ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ANN
Last Name:GAYESKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:ADIB-SAMII
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2185 W GRANT LINE RD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7309
Mailing Address - Country:US
Mailing Address - Phone:209-839-6234
Mailing Address - Fax:
Practice Address - Street 1:2185 W GRANT LINE RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7309
Practice Address - Country:US
Practice Address - Phone:209-839-6234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20058103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist