Provider Demographics
NPI:1740746163
Name:MATHIESON, TRISHA A (MS ED)
Entity Type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:A
Last Name:MATHIESON
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 71ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1017
Mailing Address - Country:US
Mailing Address - Phone:917-446-3560
Mailing Address - Fax:
Practice Address - Street 1:858 71ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1017
Practice Address - Country:US
Practice Address - Phone:917-446-3560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist