Provider Demographics
NPI:1972219053
Name:PIPER, ANDIE LAUREN
Entity Type:Individual
Prefix:
First Name:ANDIE
Middle Name:LAUREN
Last Name:PIPER
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 1:790 E BROWARD BLVD APT 311
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2896
Mailing Address - Country:US
Mailing Address - Phone:954-397-5451
Mailing Address - Fax:
Practice Address - Street 1:790 E BROWARD BLVD APT 311
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2896
Practice Address - Country:US
Practice Address - Phone:954-397-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21756101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health