Provider Demographics
NPI:1083880140
Name:HANNOLD, ANDREA DENISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DENISE
Last Name:HANNOLD
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 1:85 5TH AVE
Mailing Address - Street 2:SUITE 926
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3019
Mailing Address - Country:US
Mailing Address - Phone:347-623-6700
Mailing Address - Fax:201-617-1537
Practice Address - Street 1:85 5TH AVE
Practice Address - Street 2:SUITE 926
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3019
Practice Address - Country:US
Practice Address - Phone:347-623-6700
Practice Address - Fax:201-617-1537
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047387-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical