Provider Demographics
NPI:1699915470
Name:BURCH, ANDREA R
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:BURCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1829
Mailing Address - Country:US
Mailing Address - Phone:607-324-9744
Mailing Address - Fax:
Practice Address - Street 1:15 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1829
Practice Address - Country:US
Practice Address - Phone:607-324-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health