Provider Demographics
NPI:1114245222
Name:METH-THORBURN, ANDREA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:METH-THORBURN
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 1:15 BELMONT PL
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4501
Mailing Address - Country:US
Mailing Address - Phone:973-594-8390
Mailing Address - Fax:
Practice Address - Street 1:15 BELMONT PL
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4501
Practice Address - Country:US
Practice Address - Phone:973-594-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054227001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical