Provider Demographics
NPI:1386845998
Name:PIATT, ANDREA L (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:PIATT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 COLUMBUS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5168
Mailing Address - Country:US
Mailing Address - Phone:617-424-0765
Mailing Address - Fax:
Practice Address - Street 1:321 COLUMBUS AVE STE 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5168
Practice Address - Country:US
Practice Address - Phone:617-424-0765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7527103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06031OtherBCBS OF MA PROVIDER #
MAW50933Medicare ID - Type Unspecified