Provider Demographics
NPI:1184722688
Name:NATHANS, ANDREA (PSYD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:NATHANS
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 1:27 HOSPITAL AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5954
Mailing Address - Country:US
Mailing Address - Phone:203-778-6440
Mailing Address - Fax:203-790-6193
Practice Address - Street 1:27 HOSPITAL AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5954
Practice Address - Country:US
Practice Address - Phone:203-778-6440
Practice Address - Fax:203-790-6193
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001863103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist