Provider Demographics
NPI:1952770786
Name:PAPOFF, TRACI AILEEN
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:AILEEN
Last Name:PAPOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 S GARFIELD ST APT 10
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5418
Mailing Address - Country:US
Mailing Address - Phone:360-878-3694
Mailing Address - Fax:
Practice Address - Street 1:3628 MADISON AVE STE 67AND10
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5069
Practice Address - Country:US
Practice Address - Phone:916-388-3231
Practice Address - Fax:916-388-3232
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor