Provider Demographics
NPI:1700934254
Name:GREEN-LEWIS, ANDREA S (LCSW-R)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:S
Last Name:GREEN-LEWIS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 BROADWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7603
Mailing Address - Country:US
Mailing Address - Phone:631-525-3475
Mailing Address - Fax:
Practice Address - Street 1:201 E 69TH ST
Practice Address - Street 2:APT. 5T
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5471
Practice Address - Country:US
Practice Address - Phone:631-525-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
072593104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker