Provider Demographics
NPI:1609347723
Name:CAPRARO, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CAPRARO
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 1:236 INDIANAPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3100
Mailing Address - Country:US
Mailing Address - Phone:708-296-3956
Mailing Address - Fax:
Practice Address - Street 1:236 INDIANAPOLIS AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3100
Practice Address - Country:US
Practice Address - Phone:708-296-3956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL523411103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool