Provider Demographics
NPI:1164620233
Name:UNGAR, TRACEY (PHD)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:UNGAR
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 1:83 SPRING ST
Mailing Address - Street 2:2 FL
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-3116
Mailing Address - Country:US
Mailing Address - Phone:973-928-5008
Mailing Address - Fax:973-928-5008
Practice Address - Street 1:156 5TH AVE
Practice Address - Street 2:SUITE 1208
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7002
Practice Address - Country:US
Practice Address - Phone:914-391-2968
Practice Address - Fax:973-928-5008
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0166271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical