Provider Demographics
NPI:1275009995
Name:MARTIN, TRISTAN KAREL (PHD,LMFT)
Entity Type:Individual
Prefix:DR
First Name:TRISTAN
Middle Name:KAREL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHD,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1644
Mailing Address - Country:US
Mailing Address - Phone:315-299-6975
Mailing Address - Fax:
Practice Address - Street 1:4500 PEWTER LANE
Practice Address - Street 2:8&9
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104
Practice Address - Country:US
Practice Address - Phone:315-299-6975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-20
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP10033106H00000X
NY001640106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist