Provider Demographics
NPI:1447480140
Name:PINKERTON, ANDREA MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:PINKERTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12335 N HUMPHREYS WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-9304
Mailing Address - Country:US
Mailing Address - Phone:415-686-7364
Mailing Address - Fax:
Practice Address - Street 1:505 SAN MARIN DR
Practice Address - Street 2:STE A150
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-1357
Practice Address - Country:US
Practice Address - Phone:415-686-7364
Practice Address - Fax:949-862-8024
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 26113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical