Provider Demographics
NPI:1376951608
Name:BIRMINGHAM, ANDREA LEE (LSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE
Last Name:BIRMINGHAM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LEE
Other - Last Name:STASKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:795 ONEHEE AVE
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1757
Mailing Address - Country:US
Mailing Address - Phone:808-727-4283
Mailing Address - Fax:
Practice Address - Street 1:795 ONEHEE AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1757
Practice Address - Country:US
Practice Address - Phone:808-727-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW2421104100000X
HI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker