MEDICARE: TIANA RAE ANDREWS LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1588438261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIANA RAE ANDREWS LMSW

Provider Business Mailing Address
First Line	:	10 GRANGER PL APT 1
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14222-3203
Country	:	US
Telephone Number	:	716-908-4948
Fax Number	:

Provider Business Practice Location Address
First Line	:	1416 SWEET HOME RD
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14228-2784
Country	:	US
Telephone Number	:	716-908-4948
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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