Provider Demographics
NPI:1437462389
Name:PROUT, TRACY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:A
Last Name:PROUT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 NORTH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-1700
Mailing Address - Country:US
Mailing Address - Phone:917-596-2958
Mailing Address - Fax:
Practice Address - Street 1:1183 NORTH AVE STE 4
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-1700
Practice Address - Country:US
Practice Address - Phone:917-596-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018680103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical