Provider Demographics
NPI:1427398767
Name:FEDERICI, TRACY MARILYN (MED)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:MARILYN
Last Name:FEDERICI
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 RIDGELAKE DR
Mailing Address - Street 2:301
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4964
Mailing Address - Country:US
Mailing Address - Phone:504-908-1432
Mailing Address - Fax:504-455-9779
Practice Address - Street 1:3100 RIDGELAKE DR
Practice Address - Street 2:301
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4964
Practice Address - Country:US
Practice Address - Phone:504-908-1432
Practice Address - Fax:504-455-9779
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-24
Last Update Date:2013-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health