Provider Demographics
NPI:1629200712
Name:ONG, TRACY MINGLI (PHD, BCBA-D)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MINGLI
Last Name:ONG
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 HELANE CT
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2659
Mailing Address - Country:US
Mailing Address - Phone:866-381-1668
Mailing Address - Fax:866-381-1668
Practice Address - Street 1:445 BELLEVUE AVE STE 201B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4923
Practice Address - Country:US
Practice Address - Phone:866-381-1668
Practice Address - Fax:866-381-1668
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-22
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 103TB0200X, 103TM1800X
CAPSY24777103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling