Healthcare Provider Details

I. General information

NPI: 1053643668
Provider Name (Legal Business Name): ANDREA WILKINSON OHLE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2010
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 FIRE ISLAND AVENUE SUITE 104
BABYLON NY
11702
US

IV. Provider business mailing address

74 FIRE ISLAND AVENUE SUITE 104
BABYLON NY
11702
US

V. Phone/Fax

Practice location:
  • Phone: 631-258-1611
  • Fax:
Mailing address:
  • Phone: 631-258-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number06-000741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: