Provider Demographics
NPI:1982967568
Name:SCHACHTNER, ANDREA KELLY
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KELLY
Last Name:SCHACHTNER
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 1:1017 CONGRESS ST
Mailing Address - Street 2:APT 1
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2717
Mailing Address - Country:US
Mailing Address - Phone:920-819-3620
Mailing Address - Fax:
Practice Address - Street 1:11 BAXTER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1801
Practice Address - Country:US
Practice Address - Phone:207-775-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5160101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor