Provider Demographics
NPI:1508932351
Name:REBER, ANDREA (LICSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:REBER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2823
Mailing Address - Country:US
Mailing Address - Phone:413-584-3556
Mailing Address - Fax:
Practice Address - Street 1:65 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-584-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10202891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1893505Medicaid
MA32862Medicaid
MAP06088OtherBLUE CROSS BLUE SHIELD
MAP06088OtherBLUE CROSS BLUE SHIELD