Provider Demographics
NPI:1104139880
Name:WALTER, ANDREA S (MFT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:S
Last Name:WALTER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5463 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1502
Mailing Address - Country:US
Mailing Address - Phone:510-301-3327
Mailing Address - Fax:
Practice Address - Street 1:3056 HILLEGASS AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2514
Practice Address - Country:US
Practice Address - Phone:510-301-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC43751106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist