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General NPI Number Information
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NPI Number | 1033736707
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Entity Type | Individual
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Provider Name | BERNETTA A ANDREWIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 4481 ASH GROVE DR STE A-D
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City | SPRINGFIELD
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State | IL
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Zip | 62711-6358
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Country | US
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Telephone | 217-717-4733
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Fax | 217-679-5981
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Provider Business Mailing Address
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Address Line | 317 E KIMBLE ST
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City | SPRINGFIELD
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State | IL
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Zip | 62703-4626
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Country | US
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Telephone | 773-993-4518
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.020822
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License Number State | IL
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