Provider Demographics
NPI:1174953418
Name:TRILLA, GINA LOUISE (BA, CAS, MSED)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LOUISE
Last Name:TRILLA
Suffix:
Gender:F
Credentials:BA, CAS, MSED
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:LOUISE
Other - Last Name:MEDICI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 FIELDSTONE DR APT 10B
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1523
Mailing Address - Country:US
Mailing Address - Phone:845-220-7526
Mailing Address - Fax:
Practice Address - Street 1:20 CEDAR ST STE 302
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5250
Practice Address - Country:US
Practice Address - Phone:914-576-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-23
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY844974252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency