| Antoinette Tristan, LMHC | |
| 
					127 W State St, Ithaca, NY 14850-5474  | |
| (607) 273-7494 | |
| Not Available | 
| Full Name | Antoinette Tristan | 
|---|---|
| Gender | Female | 
| Speciality | Counselor | 
| Location | 127 W State St, Ithaca, New York | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1205204401 | NPI | - | NPPES | 
| 1336163963 | Medicaid | NY | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary | 
| Entity Name | Family & Childrens Service Of Ithaca Inc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1124176680 PECOS PAC ID: 0446249957 Enrollment ID: O20040510001270  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Antoinette Tristan, LMHC 127 W State St, Ithaca, NY 14850-5474 Ph: (607) 273-7494  | Antoinette Tristan, LMHC 127 W State St, Ithaca, NY 14850-5474 Ph: (607) 273-7494  | 
Peter Dodge, LMSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 334 W State St, Ithaca, NY 14850 Phone: 607-273-5500 Fax: 607-273-1277  | |
Andrea Arden Gerding, MSW Counselor Medicare: Accepting Medicare Assignments Practice Location: 201 E Green St Fl 5, Ithaca, NY 14850 Phone: 607-274-6288 Fax: 607-274-6280  | |
Dr. Dannemart Pierre, PHD, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1022 Danby Rd, Ithaca, NY 14850 Phone: 561-320-1179  | |
Mrs. Amy Abbasov, M.ED. LPC-S Counselor Medicare: Not Enrolled in Medicare Practice Location: 23 Besemer Ln, Ithaca, NY 14850 Phone: 806-236-4156  | |
Mr. Allen John Agnew, CASAC NYS 13121 Counselor Medicare: Not Enrolled in Medicare Practice Location: 201 E Green St, Suite 500, Ithaca, NY 14850 Phone: 607-274-6288 Fax: 607-274-6280  | |
Vanessa Hendrickson,  Counselor Medicare: Not Enrolled in Medicare Practice Location: 201 E Green St Ste 500, Ithaca, NY 14850 Phone: 607-274-6288 Fax: 607-274-6280  | |
Mr. Colin Andrew Polnitsky, MSW INTERN Counselor Medicare: Not Enrolled in Medicare Practice Location: 201 E Green St, Ithaca, NY 14850 Phone: 607-274-6288 Fax: 607-274-6280  |