Provider Demographics
NPI:1295049336
Name:HALSTEAD, TRACY CARMELA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:CARMELA
Last Name:HALSTEAD
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 1:3007 WASHINGTON BLVD
Mailing Address - Street 2:SUITE 230B
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5561
Mailing Address - Country:US
Mailing Address - Phone:310-306-2020
Mailing Address - Fax:310-305-8407
Practice Address - Street 1:3007 WASHINGTON BLVD
Practice Address - Street 2:SUITE 230B
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5561
Practice Address - Country:US
Practice Address - Phone:310-306-2020
Practice Address - Fax:310-305-8407
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23345103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical