Provider Demographics
NPI:1891557146
Name:CRISS, ANDREA P (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:P
Last Name:CRISS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CARNEY ST APT 308
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-4377
Mailing Address - Country:US
Mailing Address - Phone:516-841-5783
Mailing Address - Fax:
Practice Address - Street 1:200 CARNEY ST APT 308
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-4377
Practice Address - Country:US
Practice Address - Phone:516-841-5783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122492104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker