Provider Demographics
NPI:1609964923
Name:HEJMANOWSKI, TRACY STEVENS (PHD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:STEVENS
Last Name:HEJMANOWSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 W YORK ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1520
Mailing Address - Country:US
Mailing Address - Phone:757-622-6794
Mailing Address - Fax:757-626-1509
Practice Address - Street 1:249 W YORK ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1520
Practice Address - Country:US
Practice Address - Phone:757-622-6794
Practice Address - Fax:757-626-1509
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10703103TC0700X
VA0810003600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010316499Medicaid