Provider Demographics
NPI:1609901107
Name:HANFORD, ANDREA LYNN (MED)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:HANFORD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 CLARIDGE ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-4534
Mailing Address - Country:US
Mailing Address - Phone:412-610-2318
Mailing Address - Fax:
Practice Address - Street 1:1229 CLARIDGE ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-4534
Practice Address - Country:US
Practice Address - Phone:412-610-2318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional