Provider Demographics
NPI:1427352145
Name:GARRETT, TRACY OZZALINE (PHD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:OZZALINE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 MONTANA AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1817
Mailing Address - Country:US
Mailing Address - Phone:202-349-8900
Mailing Address - Fax:202-349-7662
Practice Address - Street 1:1933 MONTANA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1817
Practice Address - Country:US
Practice Address - Phone:202-349-8900
Practice Address - Fax:202-349-7662
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000090103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC023750200Medicaid