Healthcare Provider Details

I. General information

NPI: 1902021033
Provider Name (Legal Business Name): P ANDREW TRENTACOSTE PSYD MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PETER ANDREW TRENTACOSTE PSYD MBA

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 SUTTON RD
ARDMORE PA
19003-3116
US

IV. Provider business mailing address

133 SUTTON RD
ARDMORE PA
19003-3116
US

V. Phone/Fax

Practice location:
  • Phone: 484-942-6987
  • Fax:
Mailing address:
  • Phone: 484-942-6987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS008864L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: