Provider Demographics
NPI:1184015562
Name:DEWEY, ANDREA J (BCBA)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:J
Last Name:DEWEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 MADISON ST
Mailing Address - Street 2:UNIT 8
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5299
Mailing Address - Country:US
Mailing Address - Phone:270-217-2808
Mailing Address - Fax:
Practice Address - Street 1:279 CLEAR SKY CT
Practice Address - Street 2:SUITE C
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5946
Practice Address - Country:US
Practice Address - Phone:270-217-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-14-16181103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ011268Medicaid
1-14-16181OtherBACB CERTIFICATION NUMBER