Provider Demographics
NPI:1992407753
Name:CONNORS, ANDREW SAMUEL
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:SAMUEL
Last Name:CONNORS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 HIDDEN VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9133
Mailing Address - Country:US
Mailing Address - Phone:585-748-8373
Mailing Address - Fax:
Practice Address - Street 1:1175 PITTSFOR-VICTOR ROAD
Practice Address - Street 2:STE 120
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3831
Practice Address - Country:US
Practice Address - Phone:585-201-8451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-P115325-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical