MEDICARE: NAOMI TRIVINO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1881364842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI TRIVINO

Provider Business Mailing Address
First Line	:	135 W 50TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10020-1201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 HOLLAND AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-9401
Country	:	US
Telephone Number	:	212-582-9100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	09/20/2021

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Directions to “ NAOMI TRIVINO ” Practice Location

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