Provider Demographics
NPI:1053041350
Name:PARKER TRIVINIA, PATRICIA (MED, LAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PARKER TRIVINIA
Suffix:
Gender:F
Credentials:MED, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HADDONTOWNE CT
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3602
Mailing Address - Country:US
Mailing Address - Phone:609-566-8607
Mailing Address - Fax:
Practice Address - Street 1:100 HADDONTOWNE CT
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3602
Practice Address - Country:US
Practice Address - Phone:609-566-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00631500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health