Provider Demographics
NPI:1477241198
Name:GIERYIC, ANDREA M (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:GIERYIC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14891 HOLE IN 1 CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7187
Mailing Address - Country:US
Mailing Address - Phone:239-834-7255
Mailing Address - Fax:
Practice Address - Street 1:14891 HOLE IN 1 CIR APT 104
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7187
Practice Address - Country:US
Practice Address - Phone:239-834-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL153211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical