Provider Demographics
NPI:1871854778
Name:TRINCHESE, MICHELLE JEANNINE (MSED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JEANNINE
Last Name:TRINCHESE
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:JEANNINE
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6179 77TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1331
Mailing Address - Country:US
Mailing Address - Phone:718-672-3267
Mailing Address - Fax:
Practice Address - Street 1:6179 77TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1331
Practice Address - Country:US
Practice Address - Phone:917-832-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000328103K00000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst