Provider Demographics
NPI:1427893999
Name:TRACY, BRAELYN (PHD)
Entity type:Individual
Prefix:DR
First Name:BRAELYN
Middle Name:
Last Name:TRACY
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 1:2001 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:15456-1029
Mailing Address - Country:US
Mailing Address - Phone:724-626-4444
Mailing Address - Fax:
Practice Address - Street 1:2001 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LEMONT FURNACE
Practice Address - State:PA
Practice Address - Zip Code:15456-1029
Practice Address - Country:US
Practice Address - Phone:724-626-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X, 103TC2200X
PASP-8693543103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPABLSOtherHIGHMARK BCBS
PA1025726530002Medicaid
PA23281OtherUPMC