| Doctor Name: | PATRICIA ANN TISTAN |
| NPI Number: | 1023032216 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 3486 |
| Business Practice Address: | 517 Newman Springs Rd Lincroft, NJ - 077381426 |
| Business Phone Number: | 7325306600 |
| Business Fax Number: | 7325837314 |
| Mailing Address: | 517 Newman Springs Rd, LINCROFT |
| State: | NJ |
| Postal Code: | 077381426 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 3486 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |