Provider Demographics
NPI:1821164179
Name:SOPKO, ANDREA DEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:DEE
Last Name:SOPKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-8944
Mailing Address - Country:US
Mailing Address - Phone:518-279-4035
Mailing Address - Fax:
Practice Address - Street 1:405 VLIET BLVD
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2019
Practice Address - Country:US
Practice Address - Phone:518-237-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016033-1103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling