Provider Demographics
NPI:1588712731
Name:WALDMAN, TRACEY LYNNE (PHD)
Entity type:Individual
Prefix:MISS
First Name:TRACEY
Middle Name:LYNNE
Last Name:WALDMAN
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 1:41 FURMAN DR
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1007
Mailing Address - Country:US
Mailing Address - Phone:201-225-1955
Mailing Address - Fax:
Practice Address - Street 1:41 FURMAN DR
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1007
Practice Address - Country:US
Practice Address - Phone:201-225-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00358700103TC0700X
NY013150-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical