Provider Demographics
NPI:1508022799
Name:FISH, TRACEY L
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:FISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CHURCH ST
Mailing Address - Street 2:CRAMER HOUSE
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1003
Mailing Address - Country:US
Mailing Address - Phone:518-584-9030
Mailing Address - Fax:518-581-1709
Practice Address - Street 1:211 CHURCH ST
Practice Address - Street 2:CRAMER HOUSE
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1003
Practice Address - Country:US
Practice Address - Phone:518-584-9030
Practice Address - Fax:518-581-1709
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator