Provider Demographics
NPI:1407517816
Name:HARMON, ANDREA SUE (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:SUE
Last Name:HARMON
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 WEST WALK
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5902
Mailing Address - Country:US
Mailing Address - Phone:318-792-8831
Mailing Address - Fax:
Practice Address - Street 1:76 WEST WALK
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-5902
Practice Address - Country:US
Practice Address - Phone:318-792-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer