Provider Demographics
NPI:1568869972
Name:SIMPSON, ANDREA (BSL)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2647
Mailing Address - Country:US
Mailing Address - Phone:484-716-0100
Mailing Address - Fax:
Practice Address - Street 1:169 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2647
Practice Address - Country:US
Practice Address - Phone:484-716-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002365103K00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist