MEDICARE: ANDREA D GRESS MSW, 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	ISW14579	FL
2	1041C0700X	Clinical Social Worker	SW19840	FL

General Provider Information

NPI Number	:	1598355067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA D GRESS MSW, LCSW

Provider Business Mailing Address
First Line	:	1110 SW 46TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-6347
Country	:	US
Telephone Number	:	314-933-0711
Fax Number	:

Provider Business Practice Location Address
First Line	:	6237 PRESIDENTIAL CT STE 110
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3508
Country	:	US
Telephone Number	:	239-451-3221
Fax Number	:

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

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	04/11/2022

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