Tracie Caccavale, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

021270 Issued in NY

Practice address

78 Quannacut Rd
Pine Bush, NY 12566-5431

Phone

(845) 873-0104

NPI assigned

May 20, 2014

Last updated

Sep 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Group practices

The Center for Discovery IncGroup PAC ID 1557250933, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Senior Care Therapy Psychology of New York PLLC

  • Clinical Psychologist
  • Flushing, NY
  • NPI 1437628203
  Medicare reassignment NPD
• The Center for Discovery Inc

  • Rural Health Clinic/Center
  • Monticello, NY
  • NPI 1275624694
  Care Compare group NPD (past)
• Vitae Health Medical New York PC

  • Internal Medicine Physician
  • Kingston, NY
  • NPI 1568169134
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1720499148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 QUANNACUT RD",
            "city": "PINE BUSH",
            "state": "NY",
            "postal_code": "125665431",
            "telephone_number": "845-873-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 QUANNACUT RD",
            "city": "PINE BUSH",
            "state": "NY",
            "postal_code": "125665431",
            "telephone_number": "845-873-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CACCAVALE",
        "first_name": "TRACIE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-20",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Imtiaz Aslam, RPH
• Jennifer M Bagley, M.S. ED.
• Jane Brady-McKane
• Damon Thomas Brecheisen, BC-HIS
• Christine Lynn Burley, RN
• Yaritza Caicedo, LMSW, CASAC
• Tina Suzette Capalbo, RN
• Theresa Caroselli, P.T.
• Autumn Abigail Cash
• John Cavalluzzi

• Clinical Psychologist in Pine Bush, NY
• Providers in Pine Bush, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.