Provider Demographics
NPI:1366911463
Name:GHERSI, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:GHERSI
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 1:5745 NW 122ND WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4021
Mailing Address - Country:US
Mailing Address - Phone:954-937-6758
Mailing Address - Fax:
Practice Address - Street 1:14359 MIRAMAR PKWY STE 504
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4134
Practice Address - Country:US
Practice Address - Phone:954-399-2637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst