Individual
KATHLEEN FENTRESS TRIPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
41-43 CRESCENT STREET, LONG ISLAND CITY, NY 11101
(718) 784-2240
Mailing address
555 BERGEN AVE, JEWISH CHILD CARE ASSOCIATION, BRONX, NY 10455-1368
(718) 742-8550
(718) 993-4345
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
654113
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401518
NY
Other
Enumeration date
09/13/2012
Last updated
03/17/2018
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