MEDICARE: MS. ANDREA CHRISTINA BAI 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	104100000X	Social Worker	67284093502	UT
2	1041C0700X	Clinical Social Worker	6728409-3501	UT

General Provider Information

NPI Number	:	1205073129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA CHRISTINA BAI LCSW

Provider Business Mailing Address
First Line	:	265 S WOODLAND HILLS DR
Second Line	:
City	:	WOODLAND HILLS
State	:	UT
Zip	:	84653-2003
Country	:	US
Telephone Number	:	801-808-2826
Fax Number	:	801-618-1714

Provider Business Practice Location Address
First Line	:	265 S WOODLAND HILLS DR
Second Line	:
City	:	WOODLAND HILLS
State	:	UT
Zip	:	84653-2003
Country	:	US
Telephone Number	:	801-808-2826
Fax Number	:	801-618-1714

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

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	03/23/2023

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