Provider Demographics
NPI:1669497533
Name:TWARDON, ANDREW (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:TWARDON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 AMSTERDAM AVE
Mailing Address - Street 2:SUITE 16C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1737
Mailing Address - Country:US
Mailing Address - Phone:212-523-2965
Mailing Address - Fax:212-636-1303
Practice Address - Street 1:1090 AMSTERDAM AVE
Practice Address - Street 2:SUITE 16C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-523-2965
Practice Address - Fax:212-636-1303
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00011814103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01434546Medicaid
NY01434546Medicaid