Provider Demographics
NPI:1497986061
Name:COLE, ANDREW JONATHAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JONATHAN
Last Name:COLE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 FOX ST
Mailing Address - Street 2:SUITE101
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1352
Mailing Address - Country:US
Mailing Address - Phone:207-728-6341
Mailing Address - Fax:207-728-7762
Practice Address - Street 1:88 FOX ST
Practice Address - Street 2:SUITE101
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1352
Practice Address - Country:US
Practice Address - Phone:207-728-6341
Practice Address - Fax:207-728-7762
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1339103T00000X
NY018192103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEJ400006271Medicare PIN