Provider Demographics
NPI:1497133557
Name:VINCENT, ANDREW (LP)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:VINCENT
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1436
Mailing Address - Country:US
Mailing Address - Phone:518-423-5157
Mailing Address - Fax:
Practice Address - Street 1:274 DELAWARE AVE STE 2B
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1436
Practice Address - Country:US
Practice Address - Phone:518-423-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-09
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023272103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling