=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245559335
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIZABETH M. ANDRESS, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2010
-----------------------------------------------------
Last Update Date | 05/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1975 E SUNRISE BLVD 629
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33304-1433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-790-4065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1975 E SUNRISE BLVD 629
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33304-1433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-790-4065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. ELIZABETH M ANDRESS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 305-790-4065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SW9164
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------