Provider Demographics
NPI:1669477402
Name:LAMB, ANDREA M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:M
Last Name:LAMB
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:109 ADAMS STREET
Mailing Address - City:SAGAMORE
Mailing Address - State:MA
Mailing Address - Zip Code:02561-0109
Mailing Address - Country:US
Mailing Address - Phone:508-888-5005
Mailing Address - Fax:508-888-5005
Practice Address - Street 1:109 ADAMS STREET
Practice Address - Street 2:
Practice Address - City:SAGAMORE
Practice Address - State:MA
Practice Address - Zip Code:02561-0109
Practice Address - Country:US
Practice Address - Phone:508-888-5005
Practice Address - Fax:508-888-5005
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107151104100000X
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1892169Medicaid
MALA P04943Medicare PIN