Provider Demographics
NPI:1144381575
Name:ANDRADE, LAURA ROSE (MFT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ROSE
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:COSTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1040 LINCOLN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125
Mailing Address - Country:US
Mailing Address - Phone:408-293-4489
Mailing Address - Fax:408-293-6188
Practice Address - Street 1:1040 LINCOLN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125
Practice Address - Country:US
Practice Address - Phone:408-293-4489
Practice Address - Fax:408-293-6188
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 13191106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist