Provider Demographics
NPI:1750710927
Name:MAULE, ANDREA B
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
Last Name:MAULE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 OLD MAIN ST STE 306
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1567
Mailing Address - Country:US
Mailing Address - Phone:860-680-8450
Mailing Address - Fax:860-955-1483
Practice Address - Street 1:750 OLD MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1567
Practice Address - Country:US
Practice Address - Phone:860-680-8450
Practice Address - Fax:860-955-1483
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional