Healthcare Provider Details

I. General information

NPI: 1245786490
Provider Name (Legal Business Name): TRISTAN VICTOR BARSKY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SPRING LN
PHILADELPHIA PA
19128-3918
US

IV. Provider business mailing address

475 SPRING LANE
PHILADELPHIA PA
19128
US

V. Phone/Fax

Practice location:
  • Phone: 215-482-5353
  • Fax: 215-482-2695
Mailing address:
  • Phone: 215-482-5353
  • Fax: 215-482-2695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS018387
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: