Provider Demographics
NPI:1790371177
Name:ATIAS, ANDREA BAILEY (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:BAILEY
Last Name:ATIAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11520 WHISPER SOUND DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2404
Mailing Address - Country:US
Mailing Address - Phone:561-870-4838
Mailing Address - Fax:
Practice Address - Street 1:4101 PARKER AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-2507
Practice Address - Country:US
Practice Address - Phone:561-616-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL173501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical