Provider Demographics
NPI:1134115421
Name:TRONCOSO, BARBARA ROSE (PHD)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ROSE
Last Name:TRONCOSO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 WESTFIELD RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1725
Mailing Address - Country:US
Mailing Address - Phone:434-975-3510
Mailing Address - Fax:434-973-0756
Practice Address - Street 1:535 WESTFIELD RD
Practice Address - Street 2:SUITE #100
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1725
Practice Address - Country:US
Practice Address - Phone:434-975-3510
Practice Address - Fax:434-973-0756
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7706898Medicaid
VAR62848Medicare UPIN
VA7706898Medicaid