Provider Demographics
NPI:1184941296
Name:THOMAS, TRACY ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ELIZABETH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 S ELISEO DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2005
Mailing Address - Country:US
Mailing Address - Phone:707-540-1592
Mailing Address - Fax:
Practice Address - Street 1:1251 S ELISEO DR
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2005
Practice Address - Country:US
Practice Address - Phone:707-540-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling