Healthcare Provider Details

I. General information

NPI: 1083154322
Provider Name (Legal Business Name): ANDREEA LOREDANA DUMITRESCU MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17810 WEXFORD TER APT 1F
JAMAICA NY
11432-3003
US

IV. Provider business mailing address

4717 39TH ST APT 3C
SUNNYSIDE NY
11104-4451
US

V. Phone/Fax

Practice location:
  • Phone: 718-658-1123
  • Fax: 718-658-7091
Mailing address:
  • Phone: 917-345-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP05300
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: