Provider Demographics
NPI:1295940286
Name:MOONEY - BRACCIO, ANDREA
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:MOONEY - BRACCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:BALISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:102 ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-6433
Mailing Address - Country:US
Mailing Address - Phone:215-412-4719
Mailing Address - Fax:
Practice Address - Street 1:102 ARBOR WAY
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-6433
Practice Address - Country:US
Practice Address - Phone:215-412-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005135L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist