Provider Demographics
NPI:1578831723
Name:ECKERLE, ANDREA RAUSO (MA CCC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:RAUSO
Last Name:ECKERLE
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2808
Mailing Address - Country:US
Mailing Address - Phone:914-741-5063
Mailing Address - Fax:914-741-5063
Practice Address - Street 1:54 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2808
Practice Address - Country:US
Practice Address - Phone:914-741-5063
Practice Address - Fax:914-741-5063
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist