Provider Demographics
NPI:1477996817
Name:PAPP, ANDREA L (LCSW-R)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:PAPP
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2344
Mailing Address - Country:US
Mailing Address - Phone:516-313-2899
Mailing Address - Fax:
Practice Address - Street 1:22 LAWRENCE AVE STE 213
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3619
Practice Address - Country:US
Practice Address - Phone:631-721-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085604-1104100000X
NY083034-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03602893Medicaid