Healthcare Provider Details

I. General information

NPI: 1104274042
Provider Name (Legal Business Name): ANDREW TILLY MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 BROADWAY
BETHLEHEM PA
18015-3904
US

IV. Provider business mailing address

4727 HARRIET LN
BETHLEHEM PA
18017
US

V. Phone/Fax

Practice location:
  • Phone: 610-799-8600
  • Fax:
Mailing address:
  • Phone: 610-751-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020609
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: