Provider Demographics
NPI:1770746448
Name:REID, ANDREA L (LMSW-CC)
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:L
Last Name:REID
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33 MOUNTAIN VIEW CRESCENT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NB
Mailing Address - Zip Code:E7L2V9
Mailing Address - Country:CA
Mailing Address - Phone:506-392-8268
Mailing Address - Fax:207-492-1139
Practice Address - Street 1:20 OLD VAN BUREN ROAD
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736
Practice Address - Country:US
Practice Address - Phone:207-492-1130
Practice Address - Fax:207-492-1139
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3023381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432364400Medicaid