Provider Demographics
NPI:1023191335
Name:SPARROW, ANDREA KELLY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KELLY
Last Name:SPARROW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KINGS DAUGHTERS DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4248
Mailing Address - Country:US
Mailing Address - Phone:502-617-0937
Mailing Address - Fax:
Practice Address - Street 1:130 KINGS DAUGHTERS DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4248
Practice Address - Country:US
Practice Address - Phone:502-617-0937
Practice Address - Fax:502-223-7491
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2525951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100471300Medicaid