Provider Demographics
NPI:1144225996
Name:ETTINGOFF, ANDREA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:S
Last Name:ETTINGOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LOCUST GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1336
Mailing Address - Country:US
Mailing Address - Phone:215-350-5273
Mailing Address - Fax:215-496-0742
Practice Address - Street 1:104 LOCUST GROVE RD
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:PA
Practice Address - Zip Code:19010-1336
Practice Address - Country:US
Practice Address - Phone:215-350-5273
Practice Address - Fax:215-496-0742
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004782-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist