Provider Demographics
NPI:1467541292
Name:CYR, ANDREA JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEAN
Last Name:CYR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1405
Mailing Address - Country:US
Mailing Address - Phone:860-377-7000
Mailing Address - Fax:860-537-5426
Practice Address - Street 1:244 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1405
Practice Address - Country:US
Practice Address - Phone:860-377-7000
Practice Address - Fax:860-537-5426
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT357924OtherMHN
CTP3632507OtherOXFORD HEALTHPLANS
CT240000706CT01OtherANTHEM BCBS