Provider Demographics
NPI:1033434782
Name:H. TAD TROUTMAN, PH.D., PSYCHOLOGIST, PLLC
Entity Type:Organization
Organization Name:H. TAD TROUTMAN, PH.D., PSYCHOLOGIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:H.
Authorized Official - Middle Name:TAD
Authorized Official - Last Name:TROUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-968-7700
Mailing Address - Street 1:10 BRENTWOOD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8022
Mailing Address - Country:US
Mailing Address - Phone:631-968-7700
Mailing Address - Fax:
Practice Address - Street 1:10 BRENTWOOD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8022
Practice Address - Country:US
Practice Address - Phone:631-968-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty