Provider Demographics
NPI:1508800541
Name:TOMSHO-DEXTER, ANDREA K (LICSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:K
Last Name:TOMSHO-DEXTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:K
Other - Last Name:TOMSHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1864
Mailing Address - Country:US
Mailing Address - Phone:413-732-7419
Mailing Address - Fax:413-781-1059
Practice Address - Street 1:110 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1864
Practice Address - Country:US
Practice Address - Phone:413-732-7419
Practice Address - Fax:413-781-1059
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004906A1041C0700X
MA1144391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical