Provider Demographics
NPI:1881309490
Name:NEWBERRY, ANDREA E (MSW, LSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 N LAWNDALE AVE # 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-7326
Mailing Address - Country:US
Mailing Address - Phone:773-420-7949
Mailing Address - Fax:
Practice Address - Street 1:3448 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-9740
Practice Address - Country:US
Practice Address - Phone:773-245-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150106931104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker