Tracey Lichner, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS016298 Issued in PA

Practice address

310 4TH Ave South
Suite 5010, PMB#93151
Minneapolis, MN 55415-3309

Phone

(612) 444-1769

NPI assigned

Mar 25, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 2, 2021 through Feb 2, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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 and National Provider Directory roles.

• CBT Solutions, LLC

  • Clinic/Center
  • Minneapolis, MN
  • NPI 1275253908
  NPD Authorized official
• University of Penn-Medical Group

  • Surgical Oncology Physician
  • Philadelphia, PA
  • NPI 1871981985
  NPD (past)

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

{
    "created_epoch": "1237939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1902048820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 4TH AVE SOUTH",
            "address_2": "SUITE 5010, PMB#93151",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554153309",
            "telephone_number": "612-444-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 4TH AVE SOUTH",
            "address_2": "SUITE 5010, PMB#93151",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554153309",
            "telephone_number": "612-444-1769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICHNER",
        "first_name": "TRACEY",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-03-25",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP5680",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS016298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Libby
• Liberated Roots Wellness
• Daniel Liberman, M.D.C.M.
• Libertae Your Mind LLC
• Emilie Liberty
• Micaela Lichtenstein
• Hannah Shacter Lichtsinn, M.D.
• Gina Liddell-Westefeld
• Emily Liddicoat, LICSW
• John R Liddicoat, M.D.

• Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.