Provider Demographics
NPI:1407418239
Name:TRAVERS, TRACEY ANN (MS)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:ANN
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 W 8TH ST APT 11G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3340
Mailing Address - Country:US
Mailing Address - Phone:347-463-7408
Mailing Address - Fax:
Practice Address - Street 1:2900 W 8TH ST APT 11G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3340
Practice Address - Country:US
Practice Address - Phone:347-463-7408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency