Provider Demographics
NPI:1518513092
Name:TRUSH, STOREY (PSYD, MSED)
Entity Type:Individual
Prefix:DR
First Name:STOREY
Middle Name:
Last Name:TRUSH
Suffix:
Gender:F
Credentials:PSYD, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 3RD AVE APT 6G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3461
Mailing Address - Country:US
Mailing Address - Phone:914-714-2744
Mailing Address - Fax:
Practice Address - Street 1:60 MADISON AVE STE 1004
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-1640
Practice Address - Country:US
Practice Address - Phone:914-714-2744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022407103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty