MEDICARE: DR. ANDREA E COLE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	5090	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	332398	OTHER		MAGELLAN
2	402373	OTHER	MA	TUFTS HEALTH PLAN
3	W05650	OTHER		BL X BL S

General Provider Information

NPI Number	:	1881723765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA E COLE PHD

Provider Business Mailing Address
First Line	:	43 CENTER ST
Second Line	:	# 305
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-3062
Country	:	US
Telephone Number	:	413-587-0728
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 CENTER ST
Second Line	:	# 305
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-3062
Country	:	US
Telephone Number	:	413-587-0728
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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