Provider Demographics
NPI:1578609293
Name:MCCRACKEN, DENNIS BAIRD (PHD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:BAIRD
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:DENNIS
Other - Middle Name:
Other - Last Name:MCCRACKEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2038 JOYCE LN
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9764
Mailing Address - Country:US
Mailing Address - Phone:707-426-5388
Mailing Address - Fax:
Practice Address - Street 1:9201 BIG HORN BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-1240
Practice Address - Country:US
Practice Address - Phone:916-478-5867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19420103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical