Provider Demographics
NPI:1467543512
Name:ARREDONDO, ANDRA IRENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANDRA
Middle Name:IRENE
Last Name:ARREDONDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANDRA
Other - Middle Name:IRENE
Other - Last Name:OZOLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:6715 CANTON ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETE
Mailing Address - State:FL
Mailing Address - Zip Code:33712
Mailing Address - Country:US
Mailing Address - Phone:727-867-4988
Mailing Address - Fax:727-867-4988
Practice Address - Street 1:3551 42ND AVE SOUTH
Practice Address - Street 2:SUITE B103
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711
Practice Address - Country:US
Practice Address - Phone:727-865-3797
Practice Address - Fax:727-864-3465
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0003040104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
K4526OtherGROUP PROVIDER #
FLZ4968WMedicare ID - Type Unspecified
K4526OtherGROUP PROVIDER #