Provider Demographics
NPI:1891076477
Name:MARCIANO, TRACY A (MS, BA, CMT)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:A
Last Name:MARCIANO
Suffix:
Gender:F
Credentials:MS, BA, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1501
Mailing Address - Country:US
Mailing Address - Phone:646-642-1421
Mailing Address - Fax:
Practice Address - Street 1:3709 CLINTON ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1501
Practice Address - Country:US
Practice Address - Phone:646-642-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJCMT173C00000X
NJMEDICAL MASSAGE175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
No173C00000XOther Service ProvidersReflexologist