Provider Demographics
NPI:1104064120
Name:ANDRADES, LENA (CASAC)
Entity type:Individual
Prefix:MS
First Name:LENA
Middle Name:
Last Name:ANDRADES
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 BAKER AVE # 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-2702
Mailing Address - Country:US
Mailing Address - Phone:718-824-0764
Mailing Address - Fax:718-503-7751
Practice Address - Street 1:624 BAKER AVE # 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2702
Practice Address - Country:US
Practice Address - Phone:718-824-0764
Practice Address - Fax:718-503-7751
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8702101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)