Provider Demographics
NPI:1407246937
Name:MENZIE, TRACY A (LP)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:A
Last Name:MENZIE
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 644
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-0644
Mailing Address - Country:US
Mailing Address - Phone:732-595-8587
Mailing Address - Fax:
Practice Address - Street 1:152 OLDWICK RD
Practice Address - Street 2:
Practice Address - City:OLDWICK
Practice Address - State:NJ
Practice Address - Zip Code:08858-7041
Practice Address - Country:US
Practice Address - Phone:908-439-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-118654103K00000X
103K00000X
NJ00234883103TS0200X
NJ35S100628700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool