Provider Demographics
NPI:1639241714
Name:HAWKINS, ANDREA D (BA,MSW)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:D
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:BA,MSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:D
Other - Last Name:WELCOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSQ
Mailing Address - Street 1:998 CROOKED HILL RD
Mailing Address - Street 2:BUILDING 69
Mailing Address - City:W BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1043
Mailing Address - Country:US
Mailing Address - Phone:631-761-4159
Mailing Address - Fax:631-761-4184
Practice Address - Street 1:998 CROOKED HILL RD
Practice Address - Street 2:BUILDING 69
Practice Address - City:W BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1043
Practice Address - Country:US
Practice Address - Phone:631-761-4159
Practice Address - Fax:631-761-4184
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1160000464171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY116000464Medicaid