Provider Demographics
NPI:1033251806
Name:STUCK, ANDREA F (PHD LISW)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:F
Last Name:STUCK
Suffix:
Gender:F
Credentials:PHD LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 EDGECLIFF DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1223
Mailing Address - Country:US
Mailing Address - Phone:614-785-1223
Mailing Address - Fax:614-785-1323
Practice Address - Street 1:870 HIGH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4139
Practice Address - Country:US
Practice Address - Phone:614-785-1223
Practice Address - Fax:614-785-1323
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00074741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical