Provider Demographics
NPI:1730564741
Name:ROUSSEAU, TRISHA G (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRISHA
Middle Name:G
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1104
Mailing Address - Country:US
Mailing Address - Phone:516-626-6710
Mailing Address - Fax:
Practice Address - Street 1:21 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1104
Practice Address - Country:US
Practice Address - Phone:516-626-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021910103TB0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral