Provider Demographics
NPI:1417380593
Name:ROOF, ANDREA PAULA (PSYD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:PAULA
Last Name:ROOF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 JAYMOR ROAD
Mailing Address - Street 2:B 150
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3853
Mailing Address - Country:US
Mailing Address - Phone:215-947-8654
Mailing Address - Fax:215-938-7607
Practice Address - Street 1:928 JAYMOR ROAD
Practice Address - Street 2:B 150
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3853
Practice Address - Country:US
Practice Address - Phone:215-947-8654
Practice Address - Fax:215-938-7607
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017394103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist