Healthcare Provider Details

I. General information

NPI: 1184263980
Provider Name (Legal Business Name): TRINITY PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2019
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 N MAPLE AVE STE 101B
RIDGEWOOD NJ
07450-3261
US

IV. Provider business mailing address

PO BOX 4
BLAUVELT NY
10913-0004
US

V. Phone/Fax

Practice location:
  • Phone: 551-250-1017
  • Fax:
Mailing address:
  • Phone: 551-250-1017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CATHERINE O'SULLIVAN
Title or Position: OWNER
Credential: PSYD
Phone: 551-250-1017