Individual
TRISHA J ROSS BARAKET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2120 SARNO RD, MELBOURNE, FL 32935
(321) 241-6800
(321) 241-6888
Mailing address
PO BOX 1137, MELBOURNE, FL 32902-1137
(321) 952-9696
(321) 952-7937
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY9255
FL
103TC0700X
Clinical Psychologist
PY 9255
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100163300
—
FL
Enumeration date
01/10/2011
Last updated
12/07/2018
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