Provider Demographics
NPI:1710047683
Name:GARD, TRACY L (PHD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:GARD
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 1:10 BENNETT AVE
Mailing Address - Street 2:APT. 5F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2102
Mailing Address - Country:US
Mailing Address - Phone:718-583-0600
Mailing Address - Fax:718-731-5317
Practice Address - Street 1:2005 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-1803
Practice Address - Country:US
Practice Address - Phone:718-583-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014625103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist