Provider Demographics
NPI:1346943412
Name:CLISCAGNE, ANDREA (MT-BC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CLISCAGNE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 MCFARLAN RANCH DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8650
Mailing Address - Country:US
Mailing Address - Phone:925-848-7462
Mailing Address - Fax:
Practice Address - Street 1:5609 MCFARLAN RANCH DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8650
Practice Address - Country:US
Practice Address - Phone:925-848-7462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16039225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist