Provider Demographics
NPI:1497069959
Name:SCARBROUGH, ANDREA JEAN
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEAN
Last Name:SCARBROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3064
Mailing Address - Country:US
Mailing Address - Phone:508-222-7525
Mailing Address - Fax:508-223-4145
Practice Address - Street 1:140 PARK ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3064
Practice Address - Country:US
Practice Address - Phone:508-222-7525
Practice Address - Fax:508-223-4145
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1309161Medicaid