Provider Demographics
NPI:1639370786
Name:ANDY, LORRAINE COLEEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:COLEEN
Last Name:ANDY
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 1:1600 S FEDERAL HWY
Mailing Address - Street 2:SUITE #202
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7500
Mailing Address - Country:US
Mailing Address - Phone:954-946-6707
Mailing Address - Fax:954-941-9264
Practice Address - Street 1:1600 S FEDERAL HWY
Practice Address - Street 2:SUITE #202
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7500
Practice Address - Country:US
Practice Address - Phone:954-946-6707
Practice Address - Fax:954-941-9264
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW77061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ095NOtherBLUE CROSS BLUE SHILED #