Provider Demographics
NPI:1194969709
Name:COLE, ANDREA (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 46TH ST STE 907
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4556
Mailing Address - Country:US
Mailing Address - Phone:617-335-0480
Mailing Address - Fax:
Practice Address - Street 1:2 W 46TH ST STE 907
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4556
Practice Address - Country:US
Practice Address - Phone:617-335-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077858104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker