Provider Demographics
NPI:1972817559
Name:TRUSSO, AMY FRANCES (LMFT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:FRANCES
Last Name:TRUSSO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PRIMROSE RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4064
Mailing Address - Country:US
Mailing Address - Phone:415-506-9646
Mailing Address - Fax:
Practice Address - Street 1:405 PRIMROSE RD
Practice Address - Street 2:SUITE 309
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4064
Practice Address - Country:US
Practice Address - Phone:415-506-9646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X, 390200000X
CALMFT 83956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program