Provider Demographics
NPI:1538677729
Name:FILLINGANE, ANDREA LEE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE
Last Name:FILLINGANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LEE
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 MONTEBELLO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1366
Mailing Address - Country:US
Mailing Address - Phone:719-545-1575
Mailing Address - Fax:719-546-1451
Practice Address - Street 1:41 MONTEBELLO RD STE 102
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1366
Practice Address - Country:US
Practice Address - Phone:719-545-1575
Practice Address - Fax:719-546-1451
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSWC.0000000363OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES