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NPI Code Detail

MEDICARE: ATHENA TRITARIS LMFT

MEDICARE: ATHENA TRITARIS LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist001381NY

General Provider Information

NPI Number : 1164931978
Entity Type Code : Individual
Provider Name (Legal Business Name) : ATHENA TRITARIS LMFT
Provider Business Mailing Address
First Line : 5990 58TH AVE
Second Line :
City : MASPETH
State : NY
Zip : 11378-3224
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3708 91ST ST STE 3A
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-7962
Country : US
Telephone Number : 718-779-2263
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2017
Last Update Date : 09/25/2017

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Directions to “ ATHENA TRITARIS LMFT” Practice Location

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