Provider Demographics
NPI:1972533727
Name:KOFFMANN, ANDREW (PHD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KOFFMANN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 TIVOLI DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-7435
Mailing Address - Country:US
Mailing Address - Phone:724-443-5377
Mailing Address - Fax:724-443-5377
Practice Address - Street 1:609 TIVOLI DR
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-7435
Practice Address - Country:US
Practice Address - Phone:724-443-5377
Practice Address - Fax:724-443-5377
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002863L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist