Provider Demographics
NPI:1669625984
Name:DWORKIS, ANDREA K (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:K
Last Name:DWORKIS
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-2013
Mailing Address - Country:US
Mailing Address - Phone:516-330-9812
Mailing Address - Fax:
Practice Address - Street 1:98 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-2013
Practice Address - Country:US
Practice Address - Phone:516-330-9812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0026383-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0026383-1OtherNY STATE LICENSE