Provider Demographics
NPI:1477649622
Name:REDDEST, ANDREA MARIE (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:REDDEST
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:TUSCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:PO BOX 933132
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0001
Mailing Address - Country:US
Mailing Address - Phone:330-564-8660
Mailing Address - Fax:
Practice Address - Street 1:676 S BROADWAY ST # 103-203
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1059
Practice Address - Country:US
Practice Address - Phone:330-564-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00056431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2314561Medicaid
OHSW31601Medicare PIN