Provider Demographics
NPI:1649373002
Name:TAYLOR, ANDREW OBER (LCSW R)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:OBER
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 EAST 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-936-9090
Mailing Address - Fax:607-936-8159
Practice Address - Street 1:145 EAST 2ND STREET
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-936-9090
Practice Address - Fax:607-936-8159
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
7339624OtherGHI
NY138267OtherVALUE OPTIONS EMPIRE PLAN