Provider Demographics
NPI:1851053664
Name:BARRAGAN, ANDREA C
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:BARRAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21510 NORTHERN BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3497
Mailing Address - Country:US
Mailing Address - Phone:718-631-1034
Mailing Address - Fax:718-631-1035
Practice Address - Street 1:21510 NORTHERN BLVD STE 202
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3497
Practice Address - Country:US
Practice Address - Phone:718-361-1034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator