Provider Demographics
NPI:1770066755
Name:CENTER FOR LOSS AND RECOVERY LLC
Entity type:Organization
Organization Name:CENTER FOR LOSS AND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:615-498-9998
Mailing Address - Street 1:115 CYNWYD RD FL 3
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3022
Mailing Address - Country:US
Mailing Address - Phone:717-429-6556
Mailing Address - Fax:
Practice Address - Street 1:115 CYNWYD RD FL 3
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3022
Practice Address - Country:US
Practice Address - Phone:717-429-6556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty