Provider Demographics
NPI:1306163167
Name:CONREY, TRACEY (MS)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:CONREY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:JARVIS BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 S RIDGEWOOD AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-3073
Mailing Address - Country:US
Mailing Address - Phone:386-492-0988
Mailing Address - Fax:386-402-4327
Practice Address - Street 1:2400 S RIDGEWOOD AVE STE 17
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3073
Practice Address - Country:US
Practice Address - Phone:386-492-0988
Practice Address - Fax:386-233-3313
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-07-3737103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst