Provider Demographics
NPI:1437707759
Name:PETSCHE, ANDREW (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:PETSCHE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CENTURY HILL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2198
Mailing Address - Country:US
Mailing Address - Phone:518-229-1692
Mailing Address - Fax:
Practice Address - Street 1:20 CENTURY HILL DR STE 202
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2198
Practice Address - Country:US
Practice Address - Phone:518-785-7283
Practice Address - Fax:518-785-7293
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023323-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist