Provider Demographics
NPI:1174012868
Name:WEST, ANDRE MOLANDO (LSW)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:MOLANDO
Last Name:WEST
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-2402
Mailing Address - Country:US
Mailing Address - Phone:724-312-2558
Mailing Address - Fax:
Practice Address - Street 1:444 DALTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-2402
Practice Address - Country:US
Practice Address - Phone:724-312-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness