Individual
PATRICIA ANN TISTAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
517 NEWMAN SPRINGS RD, LINCROFT, NJ 07738-1426
(732) 530-6600
(732) 583-7314
Mailing address
517 NEWMAN SPRINGS RD, LINCROFT, NJ 07738-1426
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3486
NJ
Other
Enumeration date
07/27/2006
Last updated
07/08/2007
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