Provider Demographics
NPI:1316313521
Name:RESTIVO, ANDREA ELIZABETH (LMSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:RESTIVO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 E. 69TH ST.
Mailing Address - Street 2:APT 9E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:216-374-3957
Mailing Address - Fax:
Practice Address - Street 1:219 E. 69TH ST.
Practice Address - Street 2:APT 9E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:216-374-3957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1841694932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health