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General NPI Number Information
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NPI Number | 1205202900
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Entity Type | Individual
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Provider Name | TARA TROUT PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 343 4TH AVE 2C
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City | BROOKLYN
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State | NY
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Zip | 11215
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Country | US
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Telephone | 929-262-0674
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Fax | 914-931-2027
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Provider Business Mailing Address
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Address Line | 800 THIRD AVE SUITE A #1183
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City | NEW YORK
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State | NY
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Zip | 10022-0030
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Country | US
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Telephone | 914-340-4203
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Fax | 914-931-2027
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 022406
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License Number State | NY
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