Provider Demographics
NPI:1750531000
Name:DA SILVA, TRACEE JOANN
Entity type:Individual
Prefix:MRS
First Name:TRACEE
Middle Name:JOANN
Last Name:DA SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACEE
Other - Middle Name:JOANN
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 GEER RD STE 102A
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2455
Mailing Address - Country:US
Mailing Address - Phone:209-262-4387
Mailing Address - Fax:
Practice Address - Street 1:2101 GEER RD STE 102A
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2455
Practice Address - Country:US
Practice Address - Phone:209-262-4387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
CA80080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program