Provider Demographics
NPI:1952457327
Name:CHAPMAN, TRACY LYNN (PSYD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 LINCOLN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3015
Mailing Address - Country:US
Mailing Address - Phone:408-650-4770
Mailing Address - Fax:
Practice Address - Street 1:1302 LINCOLN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3015
Practice Address - Country:US
Practice Address - Phone:408-650-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18406103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical