MEDICARE: MRS. ANDREA LEIGH CAGGIANO LCSW, CAC II

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	080456	NY
2	104100000X	Social Worker	M-07831	NM
3	1041C0700X	Clinical Social Worker	CSW 09924286	CO

General Provider Information

NPI Number	:	1639495377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA LEIGH CAGGIANO LCSW, CAC II

Provider Business Mailing Address
First Line	:	2719 CHAPARRAL DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2619
Country	:	US
Telephone Number	:	716-909-4996
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 W 29TH ST
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-2459
Country	:	US
Telephone Number	:	970-541-1013
Fax Number	:

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

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	04/11/2017

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