Provider Demographics
NPI:1871047688
Name:BASKIN, ANDREA (MS, LMHC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BASKIN
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 S OCEAN DR
Mailing Address - Street 2:APT 3109
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7696
Mailing Address - Country:US
Mailing Address - Phone:954-330-1042
Mailing Address - Fax:
Practice Address - Street 1:1495 N PARK DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3215
Practice Address - Country:US
Practice Address - Phone:954-330-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health