Provider Demographics
NPI:1003515982
Name:PRIMELLES, ANDREA PILAR
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:PILAR
Last Name:PRIMELLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 SW 93RD ST
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2045
Mailing Address - Country:US
Mailing Address - Phone:786-247-6252
Mailing Address - Fax:
Practice Address - Street 1:10205 S DIXIE HWY STE 203
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-3168
Practice Address - Country:US
Practice Address - Phone:305-662-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL163351041C0700X
FL220231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical