Provider Demographics
NPI:1720350796
Name:FURGALA, ANDREA NICOLE (LISW-CP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
Last Name:FURGALA
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:NICOLE
Other - Last Name:MASIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:14 MANLY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-5902
Mailing Address - Country:US
Mailing Address - Phone:914-475-0497
Mailing Address - Fax:
Practice Address - Street 1:14 MANLY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3023
Practice Address - Country:US
Practice Address - Phone:914-475-0497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC115111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical