Provider Demographics
NPI:1619056108
Name:SEUBERT, ANDREW JOHN (MA)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOHN
Last Name:SEUBERT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 N FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BURDETT
Mailing Address - State:NY
Mailing Address - Zip Code:14818-9639
Mailing Address - Country:US
Mailing Address - Phone:607-703-0510
Mailing Address - Fax:607-703-0510
Practice Address - Street 1:3835 N FALLS RD
Practice Address - Street 2:
Practice Address - City:BURDETT
Practice Address - State:NY
Practice Address - Zip Code:14818-9639
Practice Address - Country:US
Practice Address - Phone:607-703-0510
Practice Address - Fax:607-703-0510
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA061619396OtherTAX IDENTIFICATION NUMBER