Provider Demographics
NPI:1437643814
Name:DINSMORE, ANDREA LYNNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LYNNE
Last Name:DINSMORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:LYNNE DINSMORE
Other - Last Name:BRIMIGION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:361 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2323
Mailing Address - Country:US
Mailing Address - Phone:774-420-3119
Mailing Address - Fax:
Practice Address - Street 1:361 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2323
Practice Address - Country:US
Practice Address - Phone:774-420-3119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9956103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist