Provider Demographics
NPI:1922616846
Name:LEBARON, TRACY (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:LEBARON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 TOWER DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2211
Mailing Address - Country:US
Mailing Address - Phone:862-703-0852
Mailing Address - Fax:
Practice Address - Street 1:80 W GRAND ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1471
Practice Address - Country:US
Practice Address - Phone:908-354-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-14-15844251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health