Provider Demographics
NPI:1396038923
Name:TRACEY POLIZZI, PSYCHOLOGY PH.D., P.C.
Entity Type:Organization
Organization Name:TRACEY POLIZZI, PSYCHOLOGY PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-825-9491
Mailing Address - Street 1:30 MINERICK DR
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1821
Mailing Address - Country:US
Mailing Address - Phone:845-825-9491
Mailing Address - Fax:
Practice Address - Street 1:572 ROUTE 303
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1941
Practice Address - Country:US
Practice Address - Phone:845-398-0934
Practice Address - Fax:845-398-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017793103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty