Provider Demographics
NPI:1194263327
Name:BLOW, TRACI M (BCBA)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:M
Last Name:BLOW
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 FOLCROFT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2801
Mailing Address - Country:US
Mailing Address - Phone:443-453-2031
Mailing Address - Fax:443-216-7397
Practice Address - Street 1:308 FOLCROFT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2801
Practice Address - Country:US
Practice Address - Phone:443-453-2031
Practice Address - Fax:443-216-7397
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA244103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst