Provider Demographics
NPI:1013299171
Name:ANDRADE, JOVAN H (MA, BCBA)
Entity type:Individual
Prefix:
First Name:JOVAN
Middle Name:H
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 BLUE LEAF CT APT M
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3709
Mailing Address - Country:US
Mailing Address - Phone:860-771-0572
Mailing Address - Fax:
Practice Address - Street 1:903 BLUE LEAF CT APT M
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-3709
Practice Address - Country:US
Practice Address - Phone:860-771-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst