Healthcare Provider Details

I. General information

NPI: 1124619242
Provider Name (Legal Business Name): LISA ANDREAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N BLACKHAWK AVE STE 104
MADISON WI
53705-3357
US

IV. Provider business mailing address

6516 MONONA DR # 156
MONONA WI
53716-4026
US

V. Phone/Fax

Practice location:
  • Phone: 608-237-8890
  • Fax: 608-237-8891
Mailing address:
  • Phone: 608-237-8890
  • Fax: 608-237-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9188-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9188-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: