Provider Demographics
NPI:1073533915
Name:TRENTACOSTI, FLORENCE L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FLORENCE
Middle Name:L
Last Name:TRENTACOSTI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 SW HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-4754
Mailing Address - Country:US
Mailing Address - Phone:563-641-6674
Mailing Address - Fax:503-641-6674
Practice Address - Street 1:1880 SW HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-4754
Practice Address - Country:US
Practice Address - Phone:563-641-6674
Practice Address - Fax:503-641-6674
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1406103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
116035OtherMANAGED HEALTH NETWORK
005440000OtherREGENCE BCBS
005440000OtherREGENCE BCBS