Healthcare Provider Details

I. General information

NPI: 1164613402
Provider Name (Legal Business Name): ANDREA MARIE HOLLERAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA MARIE LOPRESTI LICSW

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BEACON HEALTH OPTIONS 500 UNICORN PARK DRIVE
WOBURN MA
01801
US

IV. Provider business mailing address

BEACON HEALTH OPTIONS 500 UNICORN PARK DRIVE
WOBURN MA
01801
US

V. Phone/Fax

Practice location:
  • Phone: 570-335-9912
  • Fax: 781-994-7668
Mailing address:
  • Phone: 570-335-9912
  • Fax: 781-994-7668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: