Provider Demographics
NPI:1073181533
Name:JOSEPH, TRACY HENDERSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:HENDERSON
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7677 OAKPORT ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-1929
Mailing Address - Country:US
Mailing Address - Phone:510-729-1956
Mailing Address - Fax:
Practice Address - Street 1:7677 OAKPORT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-1929
Practice Address - Country:US
Practice Address - Phone:510-297-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical