Provider Demographics
NPI:1376895870
Name:KETTERING, TRACY LYNNE (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LYNNE
Last Name:KETTERING
Suffix:
Gender:F
Credentials:PHD, BCBA-D
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Other - First Name:
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Mailing Address - Street 1:1255 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3220
Mailing Address - Country:US
Mailing Address - Phone:844-234-8387
Mailing Address - Fax:856-429-4755
Practice Address - Street 1:311 WALTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9579
Practice Address - Country:US
Practice Address - Phone:844-234-8387
Practice Address - Fax:856-429-4755
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ1062808103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst