Provider Demographics
NPI:1548744535
Name:JOSSELYN, TRACY MICHELE
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MICHELE
Last Name:JOSSELYN
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 1:745 ATLANTIC AVE FL 8
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-2735
Mailing Address - Country:US
Mailing Address - Phone:888-750-7768
Mailing Address - Fax:888-750-7768
Practice Address - Street 1:745 ATLANTIC AVE FL 8
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-2735
Practice Address - Country:US
Practice Address - Phone:888-750-7768
Practice Address - Fax:888-750-7768
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician