Provider Demographics
NPI:1720536055
Name:LANTZ, ANDREA M (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:LANTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:ELBERFELD
Mailing Address - State:IN
Mailing Address - Zip Code:47613-0112
Mailing Address - Country:US
Mailing Address - Phone:812-455-1371
Mailing Address - Fax:
Practice Address - Street 1:20000 BARTON RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-7845
Practice Address - Country:US
Practice Address - Phone:812-455-1371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007555A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical