1639508807 NPI number — DR. ANDREA CHRISTINE THATCHER PSYCHOLOGIST

Table of content: DR. ANDREA CHRISTINE THATCHER PSYCHOLOGIST (NPI 1639508807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639508807 NPI number — DR. ANDREA CHRISTINE THATCHER PSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THATCHER
Provider First Name:
ANDREA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYCHOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639508807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10021 WATER WORKS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERVIEW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33578-5304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-677-6444
Provider Business Mailing Address Fax Number:
813-677-7999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10021 WATER WORKS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33578-5304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-677-6444
Provider Business Practice Location Address Fax Number:
813-677-7999
Provider Enumeration Date:
11/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY8912 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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