Provider Demographics
NPI:1003126160
Name:FLOREZ MARINO, ANDREA CAROLINA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CAROLINA
Last Name:FLOREZ MARINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CAYUGA RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1950
Mailing Address - Country:US
Mailing Address - Phone:716-819-3420
Mailing Address - Fax:716-819-3430
Practice Address - Street 1:430 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1886
Practice Address - Country:US
Practice Address - Phone:716-853-1335
Practice Address - Fax:716-853-1598
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC2000012101YM0800X
101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker