Provider Demographics
NPI:1205202900
Name:TROUT, TARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:TROUT
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 1:800 THIRD AVE
Mailing Address - Street 2:SUITE A #1183
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-0030
Mailing Address - Country:US
Mailing Address - Phone:914-340-4203
Mailing Address - Fax:914-931-2027
Practice Address - Street 1:343 4TH AVE
Practice Address - Street 2:2C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:929-262-0674
Practice Address - Fax:914-931-2027
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022406103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205202900OtherWORK