Provider Demographics
NPI:1881239648
Name:CAVALUZZI, ANDREA BETH (PMHNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:BETH
Last Name:CAVALUZZI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:BETH
Other - Last Name:CAVALUZZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1019 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3332
Mailing Address - Country:US
Mailing Address - Phone:607-733-5696
Mailing Address - Fax:
Practice Address - Street 1:1019 E WATER ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3332
Practice Address - Country:US
Practice Address - Phone:607-733-5696
Practice Address - Fax:607-733-2713
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY477457163WP0808X
NY405026363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health