Provider Demographics
NPI:1063678316
Name:WOOD, TRACY LEIGH (MED, LMFT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEIGH
Last Name:WOOD
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE STATION CIRCLE
Mailing Address - Street 2:SUITE TWO
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072
Mailing Address - Country:US
Mailing Address - Phone:215-429-1876
Mailing Address - Fax:
Practice Address - Street 1:ONE STATION CIRCLE
Practice Address - Street 2:SUITE TWO
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:215-429-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist