Provider Demographics
NPI:1164187456
Name:ANDREE, TYSON W
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:W
Last Name:ANDREE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EASTBROOK RD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-2048
Mailing Address - Country:US
Mailing Address - Phone:857-200-9813
Mailing Address - Fax:
Practice Address - Street 1:30 EASTBROOK RD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2048
Practice Address - Country:US
Practice Address - Phone:857-200-9813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical