Provider Demographics
NPI:1962752477
Name:SCHERDELL, TRACI MARIE (PSYD)
Entity type:Individual
Prefix:MS
First Name:TRACI
Middle Name:MARIE
Last Name:SCHERDELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 10TH ST APT 3103
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1440
Mailing Address - Country:US
Mailing Address - Phone:608-436-0131
Mailing Address - Fax:
Practice Address - Street 1:375 LAGUNA HONDA BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1499
Practice Address - Country:US
Practice Address - Phone:628-217-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28685103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation