Provider Demographics
NPI:1043669922
Name:ANSOLA, ANDY
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:ANSOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 NW 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3262
Mailing Address - Country:US
Mailing Address - Phone:954-274-7233
Mailing Address - Fax:877-795-9105
Practice Address - Street 1:2411 NW 98TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-3262
Practice Address - Country:US
Practice Address - Phone:954-274-7233
Practice Address - Fax:877-795-9105
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health