Fanny Estela Tristan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

083328 Issued in NY

Practice address

2090 Adam Clayton Powell Jr Blvd
7TH Floor
New York, NY 10027-4990

Phone

(917) 485-7280

Fax

(718) 772-0289

NPI assigned

Jul 20, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fanny Tristan, LCSW, PLLC

  • Clinical Social Worker
  • New York, NY
  • NPI 1578360640
  NPD Authorized official
• Epilepsy & Neurophysiology Medical Consulting PC

  • Neurology Physician
  • White Plains, NY
  • NPI 1770564593

  Clinical

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478476800000",
    "number": "1457606907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 OCEAN AVE APT 3A",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112307432",
            "telephone_number": "914-806-6527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 ADAM CLAYTON POWELL JR BLVD",
            "address_2": "7TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274990",
            "telephone_number": "917-485-7280",
            "fax_number": "718-772-0289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRISTAN",
        "first_name": "FANNY",
        "middle_name": "ESTELA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-20",
        "last_updated": "2016-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "080901",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "083328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Triska Psychotherapy LCSW PLLC
• Andrew Maxwell Triska, LCSW
• Katrina A Trisko, RDN, CDN
• Joo Hee Sohn Trisolini
• Panida Trisorn, RN
• Tristar Diagnostic
• Tristate Physician Services PC (Tristate Ziphycare Medical)
• Tristate Vascular Care PC
• Tritone Health, Inc
• Claire Tritschler, PA-C

• Clinical Social Worker in New York, NY
• Providers in New York, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.