Provider Demographics
NPI:1144462953
Name:POLIZZI, TRACEY E (PHD)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:E
Last Name:POLIZZI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MINERICK DR
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1821
Mailing Address - Country:US
Mailing Address - Phone:845-825-9491
Mailing Address - Fax:
Practice Address - Street 1:572 ROUTE 303
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1941
Practice Address - Country:US
Practice Address - Phone:845-398-0934
Practice Address - Fax:845-398-0913
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017793103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical