Provider Demographics
NPI:1649778556
Name:WAINER, ANDREA B (LCSW-R)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
Last Name:WAINER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 DIVISION ST W STE 4
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6806
Mailing Address - Country:US
Mailing Address - Phone:914-727-9428
Mailing Address - Fax:
Practice Address - Street 1:29 DIVISION ST W STE 4
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6806
Practice Address - Country:US
Practice Address - Phone:914-565-3727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047492-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker