Healthcare Provider Details

I. General information

NPI: 1992121438
Provider Name (Legal Business Name): ANDREA OLIVIA HOWARD-LAWRENCE M.S.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17210 133RD AVE APT. 12E
ROCHDALE VILLAGE NY
11434-3958
US

IV. Provider business mailing address

17210 133RD AVE APT. 12E
ROCHDALE VILLAGE NY
11434-3958
US

V. Phone/Fax

Practice location:
  • Phone: 917-592-7580
  • Fax:
Mailing address:
  • Phone: 917-592-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number547328111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: