Provider Demographics
NPI:1407629561
Name:ANDREU, GRETTER BEATRIZ (BACB983787)
Entity Type:Individual
Prefix:MRS
First Name:GRETTER
Middle Name:BEATRIZ
Last Name:ANDREU
Suffix:
Gender:M
Credentials:BACB983787
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 GLENN PKWY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6323
Mailing Address - Country:US
Mailing Address - Phone:954-914-1764
Mailing Address - Fax:
Practice Address - Street 1:315 GLENN PKWY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6323
Practice Address - Country:US
Practice Address - Phone:954-914-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB983787106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician