Provider Demographics
NPI:1952526352
Name:LABINE, ANDREA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:LABINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 W MASON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-1842
Mailing Address - Country:US
Mailing Address - Phone:920-965-7713
Mailing Address - Fax:920-496-7922
Practice Address - Street 1:1039 W MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-1842
Practice Address - Country:US
Practice Address - Phone:920-965-7713
Practice Address - Fax:920-496-7922
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2463-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical