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General NPI Number Information
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NPI Number | 1639358112
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Entity Type | Individual
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Provider Name | ANDREA KAREN SANDORA LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 3970 N OAKLAND AVE STE 502
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City | MILWAUKEE
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State | WI
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Zip | 53211
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Country | US
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Telephone | 414-533-7584
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Fax |
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Provider Business Mailing Address
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Address Line | 6048 N KENT AVE
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City | WHITEFISH BAY
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State | WI
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Zip | 53217-4644
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Country | US
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Telephone | 415-810-8247
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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 | 8831-123
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License Number State | WI
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