Provider Demographics
NPI:1275934457
Name:BANGAR, TRACY L
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:BANGAR
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 1:7600 E. GRAVES AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3414
Mailing Address - Country:US
Mailing Address - Phone:626-280-6510
Mailing Address - Fax:626-288-1026
Practice Address - Street 1:7600 E. GRAVES AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3414
Practice Address - Country:US
Practice Address - Phone:626-280-6510
Practice Address - Fax:626-288-1026
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW62025104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker