Provider Demographics
NPI:1134545734
Name:MEASE, ANDREA (LSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MEASE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2308
Mailing Address - Country:US
Mailing Address - Phone:610-435-4151
Mailing Address - Fax:610-435-3044
Practice Address - Street 1:1405 N CEDAR CREST BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2308
Practice Address - Country:US
Practice Address - Phone:610-435-4151
Practice Address - Fax:610-435-3044
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130509103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst