Provider Demographics
NPI:1881768836
Name:ANDRADE, JASON CHRISTOPHER
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JASON
Other - Middle Name:CHRISTOPHER
Other - Last Name:ANDRADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:187 BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-316-5403
Mailing Address - Fax:
Practice Address - Street 1:190 WESTBROCK RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426
Practice Address - Country:US
Practice Address - Phone:860-316-5403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health