Provider Demographics
NPI:1790375293
Name:BAXTER, ANDREA L (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:BAXTER
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 1:4545 HAZELTINE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2829
Mailing Address - Country:US
Mailing Address - Phone:310-430-8002
Mailing Address - Fax:
Practice Address - Street 1:4545 HAZELTINE AVE APT 3
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2829
Practice Address - Country:US
Practice Address - Phone:310-430-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA985831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical