Provider Demographics
NPI:1174983324
Name:SEPULVEDA, ANDREA
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:SEPULVEDA
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 1:414 W 48TH ST
Mailing Address - Street 2:APT 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-1233
Mailing Address - Country:US
Mailing Address - Phone:917-297-6644
Mailing Address - Fax:
Practice Address - Street 1:414 W 48TH ST
Practice Address - Street 2:APT 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-1233
Practice Address - Country:US
Practice Address - Phone:917-297-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst