Provider Demographics
NPI:1013077783
Name:CORN, ANDREA S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:S
Last Name:CORN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S. OCEAN BLVD
Mailing Address - Street 2:#2004
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432
Mailing Address - Country:US
Mailing Address - Phone:954-942-3344
Mailing Address - Fax:954-943-9300
Practice Address - Street 1:150 E. PALMETTO PARK RD.
Practice Address - Street 2:8TH FLOOR EXECUTIVE SUITES
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:954-942-3344
Practice Address - Fax:954-943-9300
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5442103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist