Provider Demographics
NPI:1609932235
Name:SMITH, TRACY CLEO (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:CLEO
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3270
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-0270
Mailing Address - Country:US
Mailing Address - Phone:628-227-5537
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 3270
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-0270
Practice Address - Country:US
Practice Address - Phone:628-227-5537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist