Basic Information
Provider Information
NPI: 1366554057
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDREWS
FirstName: BRIAN
MiddleName: PAUL
NamePrefix: DR.
NameSuffix:  
Credential: PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 NORTH 7TH STREET
Address2:  
City: LEBANON
State: PA
PostalCode: 17046
CountryCode: US
TelephoneNumber: 7172731710
FaxNumber: 7172731416
Practice Location
Address1: 1 GREYSTONE RD
Address2:  
City: CARLISLE
State: PA
PostalCode: 17013
CountryCode: US
TelephoneNumber: 7172459255
FaxNumber: 7172459198
Other Information
ProviderEnumerationDate: 08/31/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XPS015424PAY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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