Provider Demographics
NPI:1326305681
Name:MORENO, TRACI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:SPRIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5335 E LONE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5529
Mailing Address - Country:US
Mailing Address - Phone:480-220-0020
Mailing Address - Fax:
Practice Address - Street 1:5335 E LONE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5529
Practice Address - Country:US
Practice Address - Phone:480-220-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22412103T00000X
AZPSY005104103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist