Healthcare Provider Details

I. General information

NPI: 1811768906
Provider Name (Legal Business Name): ANDREA BIRCH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 E MAIN ST STE F5
MOUNT KISCO NY
10549-2319
US

IV. Provider business mailing address

153 E MAIN ST STE F5
MOUNT KISCO NY
10549-2319
US

V. Phone/Fax

Practice location:
  • Phone: 914-218-7948
  • Fax:
Mailing address:
  • Phone: 914-218-7948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number002674-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: