Provider Demographics
NPI:1891914768
Name:CORNELL, TRENT E (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:E
Last Name:CORNELL
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Gender:M
Credentials:PHD
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Mailing Address - Street 1:24445 HAWTHORNE BLVD
Mailing Address - Street 2:105
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6562
Mailing Address - Country:US
Mailing Address - Phone:831-375-1605
Mailing Address - Fax:831-375-1605
Practice Address - Street 1:660 CAMINO AGUAJITO
Practice Address - Street 2:203
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3654
Practice Address - Country:US
Practice Address - Phone:831-375-1605
Practice Address - Fax:831-375-1605
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAPSY7185103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY7185OtherCLINICAL PSYCHOLOGIST