Healthcare Provider Details

I. General information

NPI: 1093808115
Provider Name (Legal Business Name): CHRISTINE SYNNOVE TRIER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 BRENTWOOD RD
BRENTWOOD NY
11717-4625
US

IV. Provider business mailing address

29 PARK PL
BROOKLYN NY
11217-3207
US

V. Phone/Fax

Practice location:
  • Phone: 631-853-7300
  • Fax:
Mailing address:
  • Phone: 718-857-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005482
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: