Provider Demographics
NPI:1053550640
Name:GLADSTONE, TRACY REBECCA (PHD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:REBECCA
Last Name:GLADSTONE
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 1:106 CENTRAL ST
Mailing Address - Street 2:WELLESLEY COLLEGE -STONE CENTER
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-8268
Mailing Address - Country:US
Mailing Address - Phone:781-283-2558
Mailing Address - Fax:
Practice Address - Street 1:106 CENTRAL ST
Practice Address - Street 2:WELLESLEY COLLEGE -STONE CENTER
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-8268
Practice Address - Country:US
Practice Address - Phone:781-283-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7410103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical