Provider Demographics
NPI:1225818487
Name:GALVIN, TRISTA ELLYN
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:ELLYN
Last Name:GALVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2706
Mailing Address - Country:US
Mailing Address - Phone:551-449-8180
Mailing Address - Fax:
Practice Address - Street 1:43 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2706
Practice Address - Country:US
Practice Address - Phone:551-449-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00702600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health