Provider Demographics
NPI:1851827018
Name:BAGALUE-TRACEY, ARLETT THERESA (RMFTI, MS)
Entity Type:Individual
Prefix:
First Name:ARLETT
Middle Name:THERESA
Last Name:BAGALUE-TRACEY
Suffix:
Gender:F
Credentials:RMFTI, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3185 NW 39TH COURT
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33309
Mailing Address - Country:US
Mailing Address - Phone:954-830-5033
Mailing Address - Fax:
Practice Address - Street 1:450 NORTH PARK ROAD STE. 600
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-929-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist