Provider Demographics
NPI:1710432943
Name:VICKERY, ANDREW COLLINS
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:COLLINS
Last Name:VICKERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 ASTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4028
Mailing Address - Country:US
Mailing Address - Phone:917-436-5271
Mailing Address - Fax:
Practice Address - Street 1:813 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-4028
Practice Address - Country:US
Practice Address - Phone:917-436-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor