MEDICARE: ANDREA DE OTT 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	58.010658	CT
2	1041C0700X	Clinical Social Worker	087417	NY

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	:	1568746188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA DE OTT LCSW

Provider Business Mailing Address
First Line	:	100 MELROSE AVE STE 103
Second Line	:
City	:	GREENWICH
State	:	CT
Zip	:	06830-6277
Country	:	US
Telephone Number	:	203-970-4738
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 PEARL ST FL 2
Second Line	:
City	:	PORT CHESTER
State	:	NY
Zip	:	10573-4611
Country	:	US
Telephone Number	:	914-265-2762
Fax Number	:

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

Provider Enumeration Date	:	09/30/2011
Last Update Date	:	06/06/2025

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