Provider Demographics
NPI:1710408059
Name:MCCOMISKEY, TRACI M (CD, CCE, CCHW, PMH-C)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:M
Last Name:MCCOMISKEY
Suffix:
Gender:F
Credentials:CD, CCE, CCHW, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CROSSLEY CT
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-2342
Mailing Address - Country:US
Mailing Address - Phone:860-867-7541
Mailing Address - Fax:
Practice Address - Street 1:15 CROSSLEY CT
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-2342
Practice Address - Country:US
Practice Address - Phone:860-867-7541
Practice Address - Fax:860-867-7541
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT188172V00000X
CT1374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker