Healthcare Provider Details

I. General information

NPI: 1013791730
Provider Name (Legal Business Name): KAYLEE ANDRUSIER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 PRESIDENT ST
BROOKLYN NY
11213-4557
US

IV. Provider business mailing address

1544 PRESIDENT ST APT P
BROOKLYN NY
11213-4586
US

V. Phone/Fax

Practice location:
  • Phone: 305-803-4075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103058
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26715
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number21803
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number117085
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: