Provider Demographics
NPI:1942353701
Name:MALTER LILLING, ANDREA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:MALTER LILLING
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 1:111 LAKE AVENUE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-3943
Mailing Address - Country:US
Mailing Address - Phone:914-337-2044
Mailing Address - Fax:
Practice Address - Street 1:111 LAKE AVENUE
Practice Address - Street 2:SUITE 4
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-3943
Practice Address - Country:US
Practice Address - Phone:914-337-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011383103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP845249OtherOXFORD HEALTHCARE
NY01891634Medicaid
NYP845249OtherOXFORD HEALTHCARE