Provider Demographics
NPI:1063681633
Name:CHAFFEE, TRACY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MARIE
Last Name:CHAFFEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5347 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5357
Mailing Address - Country:US
Mailing Address - Phone:562-434-3374
Mailing Address - Fax:
Practice Address - Street 1:5347 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5357
Practice Address - Country:US
Practice Address - Phone:562-434-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG702182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry