Provider Demographics
NPI:1720556277
Name:WALLISER, TRISTANNE LESLIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:TRISTANNE
Middle Name:LESLIE
Last Name:WALLISER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 JORALEMON ST FL 6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4326
Mailing Address - Country:US
Mailing Address - Phone:718-875-3500
Mailing Address - Fax:
Practice Address - Street 1:186 JORALEMON ST FL 6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4326
Practice Address - Country:US
Practice Address - Phone:718-875-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095798104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker