MEDICARE: ANDREA N CONDELL LMSW

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	095368	NY
2	1041C0700X	Clinical Social Worker	102965	NY

General Provider Information

NPI Number	:	1861920043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA N CONDELL LMSW

Provider Business Mailing Address
First Line	:	1622 CENTRAL AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4002
Country	:	US
Telephone Number	:	718-327-9001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1622 CENTRAL AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4002
Country	:	US
Telephone Number	:	718-327-9001
Fax Number	:

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

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	05/30/2026

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