Provider Demographics
NPI:1275833642
Name:TRACY, REINE E
Entity Type:Individual
Prefix:MRS
First Name:REINE
Middle Name:E
Last Name:TRACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 GRAY RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4290
Mailing Address - Country:US
Mailing Address - Phone:207-892-1820
Mailing Address - Fax:207-892-1826
Practice Address - Street 1:408 GRAY RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4290
Practice Address - Country:US
Practice Address - Phone:207-892-1820
Practice Address - Fax:207-892-1826
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool