Provider Demographics
NPI:1255653069
Name:GLIDDEN-TRACEY, CYNTHIA ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ELLEN
Last Name:GLIDDEN-TRACEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:CINDI
Other - Middle Name:
Other - Last Name:GLIDDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1351 N ALMA SCHOOL RD
Mailing Address - Street 2:SUITE #205
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5936
Mailing Address - Country:US
Mailing Address - Phone:480-491-7048
Mailing Address - Fax:480-963-2036
Practice Address - Street 1:1351 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE #205
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5936
Practice Address - Country:US
Practice Address - Phone:480-491-7048
Practice Address - Fax:480-963-2036
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3406103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12059824OtherCAQH ID#