Provider Demographics
NPI:1912941840
Name:LEVY, ANDREA LYDIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LYDIA
Last Name:LEVY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3571 MAGELLAN CIR
Mailing Address - Street 2:CONDO # 341
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3718
Mailing Address - Country:US
Mailing Address - Phone:786-210-4214
Mailing Address - Fax:305-466-8394
Practice Address - Street 1:3571 MAGELLAN CIR
Practice Address - Street 2:CONDO # 341
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3718
Practice Address - Country:US
Practice Address - Phone:786-210-4214
Practice Address - Fax:305-466-8394
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW25111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3758Medicare ID - Type UnspecifiedMENTAL HEALTH PROVIDER ID