MEDICARE: ANDREA NOELLE DIEMERT LMFT, LAADC, ICAADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LR10120122	CA
2	101YP2500X	Professional Counselor	130217	CA

General Provider Information

NPI Number	:	1396491585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA NOELLE DIEMERT LMFT, LAADC, ICAADC

Provider Business Mailing Address
First Line	:	9266 PASCAL CT
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-4633
Country	:	US
Telephone Number	:	562-206-5444
Fax Number	:

Provider Business Practice Location Address
First Line	:	4125 TEMESCAL ST
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-7558
Country	:	US
Telephone Number	:	562-206-5444
Fax Number	:

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

Provider Enumeration Date	:	02/25/2022
Last Update Date	:	02/25/2022

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