Provider Demographics
NPI:1699939397
Name:HENRY, ANDREA K (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:K
Last Name:HENRY
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 1:45 BIRCH ST
Mailing Address - Street 2:20F
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1000
Mailing Address - Country:US
Mailing Address - Phone:518-265-7969
Mailing Address - Fax:
Practice Address - Street 1:45 BIRCH ST
Practice Address - Street 2:20F
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1000
Practice Address - Country:US
Practice Address - Phone:518-265-7969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical