Provider Demographics
NPI:1326749730
Name:MOSCHOPOULOS, ANDREA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MOSCHOPOULOS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 PORTLAND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1713
Mailing Address - Country:US
Mailing Address - Phone:857-327-7720
Mailing Address - Fax:857-327-9178
Practice Address - Street 1:175 PORTLAND ST FL 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1713
Practice Address - Country:US
Practice Address - Phone:857-327-7720
Practice Address - Fax:857-327-9178
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH086290-23363LP0808X
MARN2298745163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health