Provider Demographics
NPI:1275259897
Name:FISHMAN, ANDREA HELENE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:HELENE
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 RUBY RED BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6115
Mailing Address - Country:US
Mailing Address - Phone:352-394-0573
Mailing Address - Fax:
Practice Address - Street 1:15232 THOROUGHBRED LN
Practice Address - Street 2:
Practice Address - City:MONTVERDE
Practice Address - State:FL
Practice Address - Zip Code:34756-3320
Practice Address - Country:US
Practice Address - Phone:516-768-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health