Provider Demographics
NPI:1326628843
Name:PAZ, ANDREA (MHC-LP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:PAZ
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 69TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1226
Mailing Address - Country:US
Mailing Address - Phone:347-684-2540
Mailing Address - Fax:
Practice Address - Street 1:4902 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4444
Practice Address - Country:US
Practice Address - Phone:646-656-0164
Practice Address - Fax:516-590-7573
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty