Provider Demographics
NPI:1740465434
Name:COLEMAN, TRACEY LYNN (PHD)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LYNN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:TRACEY
Other - Middle Name:LYNN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10422 SPENCER COURT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721
Mailing Address - Country:US
Mailing Address - Phone:443-547-4074
Mailing Address - Fax:
Practice Address - Street 1:10400 SHAKER DRIVE
Practice Address - Street 2:#307
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:21150
Practice Address - Country:US
Practice Address - Phone:410-929-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-01
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05633103TC0700X
VA0119001008225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist