Provider Demographics
NPI:1770819625
Name:FALCONIO, ANDREW I
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:FALCONIO
Suffix:I
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 1:460 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3653
Mailing Address - Country:US
Mailing Address - Phone:508-790-3375
Mailing Address - Fax:508-790-3304
Practice Address - Street 1:460 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3653
Practice Address - Country:US
Practice Address - Phone:508-790-3375
Practice Address - Fax:508-790-3304
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA115288104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker