Provider Demographics
NPI:1730626946
Name:BOYD, TRACY MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:MARIE
Last Name:BOYD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:BREMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1816 BARRINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3060
Mailing Address - Country:US
Mailing Address - Phone:321-289-6875
Mailing Address - Fax:
Practice Address - Street 1:3880 CATALINA ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2211
Practice Address - Country:US
Practice Address - Phone:321-408-4162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019942300Medicaid