Healthcare Provider Details

I. General information

NPI: 1578798716
Provider Name (Legal Business Name): ANDREA MARIE KRAUSE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10502 SATELLITE BLVD STE D
ORLANDO FL
32837-8479
US

IV. Provider business mailing address

10502 SATELLITE BLVD SUITE D
ORLANDO FL
32837-8479
US

V. Phone/Fax

Practice location:
  • Phone: 407-850-9141
  • Fax: 407-850-9687
Mailing address:
  • Phone: 407-850-9141
  • Fax: 407-850-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: