Provider Demographics
NPI:1033673231
Name:VIRDO, ANDREA J (MS)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:J
Last Name:VIRDO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 NE 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-3652
Mailing Address - Country:US
Mailing Address - Phone:305-409-7338
Mailing Address - Fax:
Practice Address - Street 1:250 CATALONIA AVE STE 305
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6730
Practice Address - Country:US
Practice Address - Phone:786-310-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV630-010-70-880-0OtherDRIVER'S LICENCSE