Provider Demographics
NPI:1457775793
Name:SOCHACZEWSKI, ANDREA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:M
Last Name:SOCHACZEWSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5965 STIRLING RD # 7009
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7225
Mailing Address - Country:US
Mailing Address - Phone:754-247-6409
Mailing Address - Fax:
Practice Address - Street 1:5965 STIRLING RD # 7009
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7225
Practice Address - Country:US
Practice Address - Phone:754-247-6409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2024-07-07
Deactivation Date:2021-12-22
Deactivation Code:
Reactivation Date:2022-02-15
Provider Licenses
StateLicense IDTaxonomies
FL11157103T00000X
NY020383103T00000X
NJ5776103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist