Provider Demographics
NPI:1194115097
Name:MOJICA, ANDREA RYAN (LMHC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:RYAN
Last Name:MOJICA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 NW 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-5042
Mailing Address - Country:US
Mailing Address - Phone:315-558-7374
Mailing Address - Fax:
Practice Address - Street 1:124 NORTHERN LIGHTS DR STE 20
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4119
Practice Address - Country:US
Practice Address - Phone:315-558-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health