MEDICARE: MS. ANDREA JEAN DOCTOR 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	LSC16960	CA

General Provider Information

NPI Number	:	1194746594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA JEAN DOCTOR LCSW

Provider Business Mailing Address
First Line	:	3835 E THOUSAND OAKS BLVD # 328
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3637
Country	:	US
Telephone Number	:	818-722-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	3835 E THOUSAND OAKS BLVD # 328
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3637
Country	:	US
Telephone Number	:	818-722-6363
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/11/2025

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