Provider Demographics
NPI:1275288094
Name:MCGORTY, ANDREA (EDS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MCGORTY
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2363
Mailing Address - Country:US
Mailing Address - Phone:860-413-9538
Mailing Address - Fax:
Practice Address - Street 1:835 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2363
Practice Address - Country:US
Practice Address - Phone:860-413-9538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst