Provider Demographics
NPI:1144530296
Name:RACHMIEL, TRACY (PHD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:RACHMIEL
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 1:777 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3409
Mailing Address - Country:US
Mailing Address - Phone:718-667-2689
Mailing Address - Fax:718-668-8054
Practice Address - Street 1:777 SEAVIEW AVE
Practice Address - Street 2:SBPC ADOLESCENT DAY TREATMENT
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3409
Practice Address - Country:US
Practice Address - Phone:718-667-2689
Practice Address - Fax:718-668-8054
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013662-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical