Provider Demographics
NPI:1750119129
Name:HANNIGAN, ANDREW TADGH (LMSW)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:TADGH
Last Name:HANNIGAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 JASON PL STE 20121
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-1909
Mailing Address - Country:US
Mailing Address - Phone:845-800-5118
Mailing Address - Fax:
Practice Address - Street 1:14 JASON PL STE 20121
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-1909
Practice Address - Country:US
Practice Address - Phone:845-800-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123319-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker