MEDICARE: NANCY Y ANDINO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05372000	NJ
2	104100000X	Social Worker	077987	NY

General Provider Information

NPI Number	:	1134422561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY Y ANDINO LCSW

Provider Business Mailing Address
First Line	:	287A CLERK ST
Second Line	:	# A4
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-2751
Country	:	US
Telephone Number	:	347-875-7003
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 38TH ST
Second Line	:	STE 210
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4848
Country	:	US
Telephone Number	:	212-748-1820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	04/14/2016

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