Provider Demographics
NPI:1134970502
Name:NOEL, ANDGIE SULLYNE (LMSW)
Entity type:Individual
Prefix:
First Name:ANDGIE
Middle Name:SULLYNE
Last Name:NOEL
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 1:24 FRANKLIN SQ
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4541
Mailing Address - Country:US
Mailing Address - Phone:347-766-3518
Mailing Address - Fax:
Practice Address - Street 1:24 FRANKLIN SQ
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-4541
Practice Address - Country:US
Practice Address - Phone:516-924-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122965-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker