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General NPI Number Information
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NPI Number | 1285106740
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Entity Type | Individual
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Provider Name | ANDRE SY AMFT
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Gender | Male
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Dates
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Enumeration Date | 12/21/2018
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 30 COUNTRY WOOD DR
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City | POMONA
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State | CA
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Zip | 91766-4818
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Country | US
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Telephone | 909-623-3400
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Fax | 909-599-8223
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Provider Business Mailing Address
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Address Line | 701 W IMPERIAL HWY APT 512
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City | LA HABRA
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State | CA
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Zip | 90631-7055
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Country | US
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Telephone | 714-928-9101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 110053
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License Number State | CA
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