MEDICARE: ANDREW JAMES ARCHER LICSW

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	1618	NH
2	1041C0700X	Clinical Social Worker
3	1041C0700X	Clinical Social Worker	21415	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396977526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW JAMES ARCHER LICSW

Provider Business Mailing Address
First Line	:	1306 MARSHALL ST
Second Line	:
City	:	SAINT PETER
State	:	MN
Zip	:	56082-4500
Country	:	US
Telephone Number	:	507-931-8040
Fax Number	:	507-931-8060

Provider Business Practice Location Address
First Line	:	1306 MARSHALL ST
Second Line	:
City	:	ST PETER
State	:	MN
Zip	:	56082-4500
Country	:	US
Telephone Number	:	507-931-8040
Fax Number	:	507-931-8060

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

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	02/16/2012

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