Provider Demographics
NPI:1356685309
Name:MORELAND, TRACY (CASE MANAGER/CSP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MORELAND
Suffix:
Gender:F
Credentials:CASE MANAGER/CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1957
Mailing Address - Country:US
Mailing Address - Phone:617-623-3278
Mailing Address - Fax:617-623-1332
Practice Address - Street 1:63 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1957
Practice Address - Country:US
Practice Address - Phone:617-623-3278
Practice Address - Fax:617-623-1332
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator