Provider Demographics
NPI:1417379405
Name:ANDINO, ANDRES RAUL
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:RAUL
Last Name:ANDINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANDRES
Other - Middle Name:RAUL
Other - Last Name:ANDINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPSY
Mailing Address - Street 1:128 AVE ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00917-2740
Mailing Address - Country:US
Mailing Address - Phone:787-220-1272
Mailing Address - Fax:
Practice Address - Street 1:128 AVE ROOSEVELT
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917-2740
Practice Address - Country:US
Practice Address - Phone:787-220-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR748101YP2500X
PR5172103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional