Provider Demographics
NPI:1558536904
Name:ANDRES, MYRA
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:ANDRES
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 1:10127 SEATTLE SLEW LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-2084
Mailing Address - Country:US
Mailing Address - Phone:808-352-0369
Mailing Address - Fax:
Practice Address - Street 1:10127 SEATTLE SLEW LN UNIT A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-2084
Practice Address - Country:US
Practice Address - Phone:808-352-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical