Provider Demographics
NPI:1962793901
Name:WRIGHT, ANDREA MARLENE (MSED)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARLENE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 UNION ST
Mailing Address - Street 2:1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1283
Mailing Address - Country:US
Mailing Address - Phone:718-221-5145
Mailing Address - Fax:718-221-5145
Practice Address - Street 1:1038 UNION ST
Practice Address - Street 2:1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1283
Practice Address - Country:US
Practice Address - Phone:718-221-5145
Practice Address - Fax:718-221-5145
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1206671174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist