Provider Demographics
NPI:1245688993
Name:ANDREA LABINE, PH.D LLC
Entity type:Organization
Organization Name:ANDREA LABINE, PH.D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:LABINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:920-965-7713
Mailing Address - Street 1:1039 W MASON ST
Mailing Address - Street 2:116
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-1842
Mailing Address - Country:US
Mailing Address - Phone:920-965-7713
Mailing Address - Fax:920-496-7922
Practice Address - Street 1:1039 W MASON ST
Practice Address - Street 2:116
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-1842
Practice Address - Country:US
Practice Address - Phone:920-965-7713
Practice Address - Fax:920-496-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty