Provider Demographics
NPI:1730664103
Name:GASIOROWSKI, ANDREA JULIETTE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JULIETTE
Last Name:GASIOROWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2487
Mailing Address - Country:US
Mailing Address - Phone:248-462-1528
Mailing Address - Fax:
Practice Address - Street 1:3604 SHANNON RD STE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6343
Practice Address - Country:US
Practice Address - Phone:877-876-3783
Practice Address - Fax:855-420-6402
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0144171041C0700X
MI6801099986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker