Provider Demographics
NPI:1053643668
Name:OHLE, ANDREA WILKINSON (LMFT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:WILKINSON
Last Name:OHLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 FIRE ISLAND AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702
Mailing Address - Country:US
Mailing Address - Phone:631-258-1611
Mailing Address - Fax:
Practice Address - Street 1:74 FIRE ISLAND AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702
Practice Address - Country:US
Practice Address - Phone:631-258-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-06
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06-000741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist