Provider Demographics
NPI:1174819221
Name:ANDRESS, CARRIE (MSC, LAC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:ANDRESS
Suffix:
Gender:F
Credentials:MSC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 ROUTE 44 55
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:NY
Mailing Address - Zip Code:12525-5053
Mailing Address - Country:US
Mailing Address - Phone:845-674-3778
Mailing Address - Fax:
Practice Address - Street 1:340 PLAZA RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2975
Practice Address - Country:US
Practice Address - Phone:845-674-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002326171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist