Provider Demographics
NPI:1508142118
Name:ANDREASEN, ANDREA LYN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYN
Last Name:ANDREASEN
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 1:5517 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4883
Mailing Address - Country:US
Mailing Address - Phone:813-493-8908
Mailing Address - Fax:813-962-4385
Practice Address - Street 1:2795 KEYSTONE RD
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-7425
Practice Address - Country:US
Practice Address - Phone:813-493-8908
Practice Address - Fax:813-962-4385
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YP1600X
FLSW10462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral