Provider Demographics
NPI:1265783831
Name:ROBINSON, TRISTAN (PHD)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 HAZELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1828
Mailing Address - Country:US
Mailing Address - Phone:302-455-8772
Mailing Address - Fax:302-416-5505
Practice Address - Street 1:646 HAZELWOOD RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003
Practice Address - Country:US
Practice Address - Phone:302-455-8772
Practice Address - Fax:302-416-5505
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018284103TC0700X
DEB1-0001135103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical