Provider Demographics
NPI:1033869847
Name:ALFRED, ANDREA (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ALFRED
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13728 W RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-7375
Mailing Address - Country:US
Mailing Address - Phone:623-466-2490
Mailing Address - Fax:
Practice Address - Street 1:13728 W RANCHO DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-7375
Practice Address - Country:US
Practice Address - Phone:623-466-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-18647104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker