Provider Demographics
NPI:1093183501
Name:ANDROMIDAS, TAYLOR L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:L
Last Name:ANDROMIDAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OVERLOOK RIDGE DR UNIT 537
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4768
Mailing Address - Country:US
Mailing Address - Phone:757-560-7773
Mailing Address - Fax:
Practice Address - Street 1:10 OVERLOOK RIDGE DR UNIT 537
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-4768
Practice Address - Country:US
Practice Address - Phone:757-560-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10396103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW0785)OtherBLUE CROSS BLUE SHIELD