Provider Demographics
NPI:1376833962
Name:CHARLESWORTH, ANDREA A (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:A
Last Name:CHARLESWORTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 TURNBURY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-8432
Mailing Address - Country:US
Mailing Address - Phone:484-919-8436
Mailing Address - Fax:
Practice Address - Street 1:201 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1952
Practice Address - Country:US
Practice Address - Phone:610-948-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional