Provider Demographics
NPI:1548086705
Name:GIAMBRA-VYE, TRACIE LYNN (LCPC-C)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:LYNN
Last Name:GIAMBRA-VYE
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 LISBON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7248
Mailing Address - Country:US
Mailing Address - Phone:207-405-7501
Mailing Address - Fax:
Practice Address - Street 1:179 LISBON ST STE 201
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7248
Practice Address - Country:US
Practice Address - Phone:207-405-7501
Practice Address - Fax:207-782-9011
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL7837101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional