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General NPI Number Information
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NPI Number | 1659741734
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Entity Type | Organization
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Legal Business Name | ANDREA TAYLOR, LCSW
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 8905 REGENTS PARK DR STE 230
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City | TAMPA
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State | FL
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Zip | 33647-3081
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Country | US
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Telephone | 850-294-1545
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Fax |
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Provider Business Mailing Address
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Address Line | 10358 LIGHTNER BRIDGE DR
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City | TAMPA
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State | FL
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Zip | 33626-1809
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Country | US
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Telephone | 850-294-1545
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | ANDREA TAYLOR
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Credential |
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Telephone | 850-294-1545
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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 | SW 9467
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License Number State | FL
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