Provider Demographics
NPI:1366012890
Name:SERVIL, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SERVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32E GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-3816
Mailing Address - Country:US
Mailing Address - Phone:908-485-9472
Mailing Address - Fax:
Practice Address - Street 1:32E GARDEN DR
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-3816
Practice Address - Country:US
Practice Address - Phone:908-485-9472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2022-08-09
Deactivation Date:2021-09-23
Deactivation Code:
Reactivation Date:2022-08-09
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06661900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker