Provider Demographics
NPI:1528307725
Name:POLLACK, TRACY ALEXANDRA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ALEXANDRA
Last Name:POLLACK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:BERK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:6399 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5703
Mailing Address - Country:US
Mailing Address - Phone:310-845-6847
Mailing Address - Fax:
Practice Address - Street 1:6399 WILSHIRE BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5703
Practice Address - Country:US
Practice Address - Phone:310-845-6847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical