MEDICARE: ANDREA SIMPSON BSL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BH002365	PA
2	174400000X	Specialist

General Provider Information

NPI Number	:	1568869972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SIMPSON BSL

Provider Business Mailing Address
First Line	:	169 LEWIS AVE
Second Line	:
City	:	EAST LANSDOWNE
State	:	PA
Zip	:	19050-2647
Country	:	US
Telephone Number	:	484-716-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 LEWIS AVE
Second Line	:
City	:	EAST LANSDOWNE
State	:	PA
Zip	:	19050-2647
Country	:	US
Telephone Number	:	484-716-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	02/12/2015

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