Provider Demographics
NPI:1740535954
Name:LEVERIDGE, ANDREA MARIANA (SPECIAL ED TEACHER)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARIANA
Last Name:LEVERIDGE
Suffix:
Gender:F
Credentials:SPECIAL ED TEACHER
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:MARIANA
Other - Last Name:DOUGLAS SARPONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ABA SPECIALIST (MED)
Mailing Address - Street 1:9 RUGBY DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4217
Mailing Address - Country:US
Mailing Address - Phone:155-157-4666
Mailing Address - Fax:
Practice Address - Street 1:348 E 146TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5702
Practice Address - Country:US
Practice Address - Phone:718-585-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY637552121103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst