Healthcare Provider Details

I. General information

NPI: 1609679166
Provider Name (Legal Business Name): ANDREA CARRIZO LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 E MURRAY HOLLADAY RD
HOLLADAY UT
84117-5382
US

IV. Provider business mailing address

308 W NORTH TEMPLE APT 345
SALT LAKE CITY UT
84103-1899
US

V. Phone/Fax

Practice location:
  • Phone: 801-913-1974
  • Fax:
Mailing address:
  • Phone: 801-913-1974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANDREA CARRIZO
Title or Position: CEO
Credential: LCSW
Phone: 801-913-1974