MEDICARE: ANGELICA ANDRADE MSW

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	71142	CA

General Provider Information

NPI Number	:	1992080196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA ANDRADE MSW

Provider Business Mailing Address
First Line	:	8465 OLD REDWOOD HWY STE 320
Second Line	:
City	:	WINDSOR
State	:	CA
Zip	:	95492-9244
Country	:	US
Telephone Number	:	707-433-5494
Fax Number	:	707-837-0119

Provider Business Practice Location Address
First Line	:	8465 OLD REDWOOD HWY STE 320
Second Line	:
City	:	WINDSOR
State	:	CA
Zip	:	95492-9244
Country	:	US
Telephone Number	:	707-433-5494
Fax Number	:	707-837-0119

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

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	09/10/2018

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