Provider Demographics
NPI:1326350729
Name:TRENT, LINDSAY RAE (PHD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:RAE
Last Name:TRENT
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 1:501 SEAPORT CT STE 201
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2769
Mailing Address - Country:US
Mailing Address - Phone:628-333-9495
Mailing Address - Fax:628-200-3350
Practice Address - Street 1:501 SEAPORT CT STE 201
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2769
Practice Address - Country:US
Practice Address - Phone:628-333-9495
Practice Address - Fax:628-200-3350
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
CA27897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA999999OtherANTHEM BLUE CROSS CALIFORNIA