Provider Demographics
NPI:1467748103
Name:TRACY, RENEE (LAC, MAOM)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:LAC, MAOM
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, MAOM
Mailing Address - Street 1:301 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-0439
Mailing Address - Country:US
Mailing Address - Phone:781-775-7705
Mailing Address - Fax:781-735-7705
Practice Address - Street 1:214 MARKET ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1946
Practice Address - Country:US
Practice Address - Phone:617-407-4565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist