Provider Demographics
NPI:1275968497
Name:GIARGIARI, TRACIE DENISE
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:DENISE
Last Name:GIARGIARI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:TRACIE
Other - Middle Name:DENISE
Other - Last Name:GIARGIARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1925 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4756
Mailing Address - Country:US
Mailing Address - Phone:303-774-9698
Mailing Address - Fax:
Practice Address - Street 1:1925 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:303-774-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0003835103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist