Provider Demographics
NPI:1164740965
Name:STARR, TRACY RAE (TRACY ZIMMERMAN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:RAE
Last Name:STARR
Suffix:
Gender:F
Credentials:TRACY ZIMMERMAN
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:780 AMERICAN LEGION HWY
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3908
Mailing Address - Country:US
Mailing Address - Phone:617-875-6312
Mailing Address - Fax:
Practice Address - Street 1:35 MEDFORD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4242
Practice Address - Country:US
Practice Address - Phone:617-875-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106H00000X106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist