Provider Demographics
NPI:1619655891
Name:CHILSON, ANDREA MAREE (MSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MAREE
Last Name:CHILSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34100 DIANTHUS LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-2987
Mailing Address - Country:US
Mailing Address - Phone:951-809-3699
Mailing Address - Fax:
Practice Address - Street 1:41689 ENTERPRISE CIR N STE 120
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5630
Practice Address - Country:US
Practice Address - Phone:951-587-4165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW112464104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker