Provider Demographics
NPI:1700131067
Name:PRIAMO, ANDREA (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:PRIAMO
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 THAMES ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFF STA
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2534
Mailing Address - Country:US
Mailing Address - Phone:631-942-8847
Mailing Address - Fax:
Practice Address - Street 1:188 THAMES ST
Practice Address - Street 2:
Practice Address - City:PORT JEFF STA
Practice Address - State:NY
Practice Address - Zip Code:11776-2534
Practice Address - Country:US
Practice Address - Phone:631-942-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111261252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency