Provider Demographics
NPI:1356736615
Name:PFEIFER, TRACY (ABA TUTOR)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:ABA TUTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 MONTANO PLAZA DR. NW
Mailing Address - Street 2:APT. 2G
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120
Mailing Address - Country:US
Mailing Address - Phone:505-715-0362
Mailing Address - Fax:
Practice Address - Street 1:8920 HOLLY AVENUE NE
Practice Address - Street 2:SUITE 102B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122
Practice Address - Country:US
Practice Address - Phone:505-856-6880
Practice Address - Fax:180-071-4470
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist