Provider Demographics
NPI:1568852887
Name:CALABRESE, ANDREA LYNN (LAC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:CALABRESE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:CT
Mailing Address - Zip Code:06043-7711
Mailing Address - Country:US
Mailing Address - Phone:860-966-3684
Mailing Address - Fax:
Practice Address - Street 1:82 WOLCOTT HILL RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1243
Practice Address - Country:US
Practice Address - Phone:860-436-6339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000604171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist