Provider Demographics
NPI:1437548476
Name:BROSS, ANDREA LISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LISA
Last Name:BROSS
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 1:195 WHITING ST
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3717
Mailing Address - Country:US
Mailing Address - Phone:781-738-6226
Mailing Address - Fax:
Practice Address - Street 1:195 WHITING ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3717
Practice Address - Country:US
Practice Address - Phone:781-738-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10050103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling