Provider Demographics
NPI:1598355067
Name:GRESS, ANDREA D (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:D
Last Name:GRESS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 SW 46TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6347
Mailing Address - Country:US
Mailing Address - Phone:314-933-0711
Mailing Address - Fax:
Practice Address - Street 1:6237 PRESIDENTIAL CT STE 110
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3508
Practice Address - Country:US
Practice Address - Phone:239-451-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW14579104100000X
FLSW198401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker