Provider Demographics
NPI:1184818460
Name:MOULLIN-HEDDLE, ANDREA JOY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JOY
Last Name:MOULLIN-HEDDLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PURDY AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4501
Mailing Address - Country:US
Mailing Address - Phone:917-751-7425
Mailing Address - Fax:
Practice Address - Street 1:5 PURDY AVE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4501
Practice Address - Country:US
Practice Address - Phone:917-751-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0682391041C0700X
NY0793641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical