Provider Demographics
NPI:1639448608
Name:KANTOR, ANDREA (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:KANTOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MARGOLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1590 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1955
Mailing Address - Country:US
Mailing Address - Phone:516-592-4054
Mailing Address - Fax:
Practice Address - Street 1:1590 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1955
Practice Address - Country:US
Practice Address - Phone:516-592-4054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011993-1103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool