Individual
ANTOINETTE TRISTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
127 W STATE ST, ITHACA, NY 14850-5474
(607) 273-7494
Mailing address
127 W STATE ST, ITHACA, NY 14850-5474
(607) 273-7494
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336163963
—
NY
Enumeration date
09/04/2015
Last updated
12/20/2022
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