Provider Demographics
NPI:1043434103
Name:BAROUCH-HEBB, ANDREA GAIL (LAC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:GAIL
Last Name:BAROUCH-HEBB
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LOIS LN
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-3539
Mailing Address - Country:US
Mailing Address - Phone:845-246-2782
Mailing Address - Fax:
Practice Address - Street 1:324 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4470
Practice Address - Country:US
Practice Address - Phone:845-331-0300
Practice Address - Fax:845-331-1130
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0031541171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist