Provider Demographics
NPI:1235535337
Name:BYARD, ANDREW JR
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:BYARD
Suffix:JR
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 1:2140 ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2828
Mailing Address - Country:US
Mailing Address - Phone:215-893-0560
Mailing Address - Fax:
Practice Address - Street 1:2140 ELLSWORTH ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19146-2828
Practice Address - Country:US
Practice Address - Phone:215-893-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool