Provider Demographics
NPI:1609918358
Name:MLYNISKA, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MLYNISKA
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 1:400 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:N ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2425
Mailing Address - Country:US
Mailing Address - Phone:617-877-8460
Mailing Address - Fax:
Practice Address - Street 1:400 SMITH ST
Practice Address - Street 2:
Practice Address - City:N ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-2425
Practice Address - Country:US
Practice Address - Phone:617-877-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health