Healthcare Provider Details

I. General information

NPI: 1174661797
Provider Name (Legal Business Name): BARBARA ANN TRILLING PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 BARD AVE
STATEN ISLAND NY
10310-2105
US

IV. Provider business mailing address

482 BARD AVE
STATEN ISLAND NY
10310-2105
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-7079
  • Fax: 718-720-6944
Mailing address:
  • Phone: 718-447-7079
  • Fax: 718-720-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005169
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number005169
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number005169
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: