Basic Information
| Provider Information | |||||||||
| NPI: | 1174894455 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORCROSS | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | CHRISTINA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCAT, MT-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 KIDS WAY | ||||||||
| Address2: | |||||||||
| City: | ALTONA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185698320 | ||||||||
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| Practice Location | |||||||||
| Address1: | 427 MARGARET ST. | ||||||||
| Address2: | NORTH COUNTRY KIDS | ||||||||
| City: | PLATTSBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185613803 | ||||||||
| FaxNumber: | 5185613805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2012 | ||||||||
| LastUpdateDate: | 01/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 221700000X | 001052 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | 225A00000X | 06635 | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist |
No ID Information.