Provider Demographics
NPI:1417308396
Name:GHOORAY, ANDREA (MSSW CSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:GHOORAY
Suffix:
Gender:F
Credentials:MSSW CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 WHIPPOORWILL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1043
Mailing Address - Country:US
Mailing Address - Phone:502-640-6409
Mailing Address - Fax:
Practice Address - Street 1:3508 WHIPPOORWILL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1043
Practice Address - Country:US
Practice Address - Phone:502-640-6409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY68171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical