Provider Demographics
NPI:1396034864
Name:CRANSTON, TRACEY (NP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:CRANSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EAST GREEN STREET
Mailing Address - Street 2:TOMPKINS COUNTY MENTAL HEALTH SERVICES
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-274-6200
Mailing Address - Fax:607-274-6316
Practice Address - Street 1:201 EAST GREEN STREET
Practice Address - Street 2:TOMPKINS COUNTY MENTAL HEALTH SERVICES
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-274-6200
Practice Address - Fax:607-274-6316
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY605876163WP0808X
NY40-401600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health