Healthcare Provider Details

I. General information

NPI: 1629402383
Provider Name (Legal Business Name): ANDREA A MONGE NISSEN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA MONGE PSY.D

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDPARK DRIVE
SOMERSET KY
42503
US

IV. Provider business mailing address

300 MEDPARK DRIVE
SOMERSET KY
42503
US

V. Phone/Fax

Practice location:
  • Phone: 606-676-0786
  • Fax:
Mailing address:
  • Phone: 606-676-0786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number173586
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number246762
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: