Provider Demographics
NPI:1346602729
Name:CHIRCHIRILLO, ANDREW (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:CHIRCHIRILLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S BEMISTON AVE
Mailing Address - Street 2:SUITE 704-A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1913
Mailing Address - Country:US
Mailing Address - Phone:314-721-2775
Mailing Address - Fax:
Practice Address - Street 1:130 S BEMISTON AVE
Practice Address - Street 2:SUITE 704-A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1913
Practice Address - Country:US
Practice Address - Phone:314-721-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00977103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent