Healthcare Provider Details

I. General information

NPI: 1063921732
Provider Name (Legal Business Name): ANDREA MCPHILLIPS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 MADISON AVE
COVINGTON KY
41011-1505
US

IV. Provider business mailing address

502 FARRELL DR
COVINGTON KY
41011-3717
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-3292
  • Fax: 859-534-2989
Mailing address:
  • Phone: 859-578-3204
  • Fax: 859-578-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255591
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: