Provider Demographics
NPI:1194851139
Name:ZAPARANICK, TRACY LEIGH (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEIGH
Last Name:ZAPARANICK
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 557 BOX 521
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96379-0006
Mailing Address - Country:US
Mailing Address - Phone:0909-850-1700
Mailing Address - Fax:
Practice Address - Street 1:18TH MEDICAL GROUP BUILDING 626
Practice Address - Street 2:UNIT 5142
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368-5142
Practice Address - Country:US
Practice Address - Phone:315-634-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000004324104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3989663Medicaid
3989663Medicare ID - Type Unspecified