Basic Information
| Provider Information | |||||||||
| NPI: | 1467733238 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PODIAS | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 DOLSON AVE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109406489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453425789 | ||||||||
| FaxNumber: | 8453440510 | ||||||||
| Practice Location | |||||||||
| Address1: | 41 DOLSON AVE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109406489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453425789 | ||||||||
| FaxNumber: | 8453440510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2011 | ||||||||
| LastUpdateDate: | 09/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P78100 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.