Provider Demographics
NPI:1578620332
Name:DAVANZO, ANDREA HOPE (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:HOPE
Last Name:DAVANZO
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:124 FRANKLIN PLACE
Mailing Address - Street 2:PENINSULA COUNSELING CENTER
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598
Mailing Address - Country:US
Mailing Address - Phone:516-569-6600
Mailing Address - Fax:516-374-2261
Practice Address - Street 1:124 FRANKLIN PLACE
Practice Address - Street 2:PENINSULA COUNSELING CENTER
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598
Practice Address - Country:US
Practice Address - Phone:516-569-6600
Practice Address - Fax:516-374-2261
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02876211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical