Provider Demographics
NPI:1033736707
Name:ANDREWIN, BERNETTA A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BERNETTA
Middle Name:A
Last Name:ANDREWIN
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 1:317 E KIMBLE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-4626
Mailing Address - Country:US
Mailing Address - Phone:773-993-4518
Mailing Address - Fax:
Practice Address - Street 1:4481 ASH GROVE DR STE A-D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6358
Practice Address - Country:US
Practice Address - Phone:217-717-4733
Practice Address - Fax:217-679-5981
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0208221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical