Provider Demographics
NPI:1932290103
Name:ZEREN, ANDREA SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:SUE
Last Name:ZEREN
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 1:2 WYMAN RD
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-3648
Mailing Address - Country:US
Mailing Address - Phone:978-744-5006
Mailing Address - Fax:978-241-7373
Practice Address - Street 1:2 WYMAN RD
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-3648
Practice Address - Country:US
Practice Address - Phone:978-744-5006
Practice Address - Fax:978-241-7373
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6628103G00000X, 103T00000X, 103TA0400X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06485OtherBCBSMA HEALTHCARE PROVIDE
MA1896091OtherMBHP HEALTH CARE PROVIDER
MA494351OtherTUFTS
MA1896091OtherMBHP HEALTH CARE PROVIDER