Provider Demographics
NPI:1992100838
Name:PASSACANTILLI, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PASSACANTILLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:FALTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 ASHCROFT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3109
Mailing Address - Country:US
Mailing Address - Phone:617-257-4815
Mailing Address - Fax:
Practice Address - Street 1:184 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-1099
Practice Address - Country:US
Practice Address - Phone:781-233-1747
Practice Address - Fax:781-233-1782
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health