Provider Demographics
NPI:1184794158
Name:COURNOYER, ANDREA LYNN (BA, LCDP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNN
Last Name:COURNOYER
Suffix:
Gender:F
Credentials:BA, LCDP
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:LYNN
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 IROQUOIS RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-5912
Mailing Address - Country:US
Mailing Address - Phone:401-741-7703
Mailing Address - Fax:401-781-2790
Practice Address - Street 1:2020 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-2404
Practice Address - Country:US
Practice Address - Phone:401-781-2700
Practice Address - Fax:401-781-2790
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00389101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RITT24187Medicaid