Provider Demographics
NPI:1740297902
Name:CUTINO, TRACY JEANNINE (MA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:JEANNINE
Last Name:CUTINO
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 1:1141 LEVER BLVD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-2855
Mailing Address - Country:US
Mailing Address - Phone:916-270-8169
Mailing Address - Fax:
Practice Address - Street 1:1141 LEVER BLVD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-2855
Practice Address - Country:US
Practice Address - Phone:916-270-8169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT# 47897106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist