Provider Demographics
NPI:1194450718
Name:JUAREZ, ANDREA YAEL
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:YAEL
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6764 S 2240 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3120
Mailing Address - Country:US
Mailing Address - Phone:385-272-4214
Mailing Address - Fax:
Practice Address - Street 1:5970 FAIRVIEW RD STE 126
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-2100
Practice Address - Country:US
Practice Address - Phone:704-412-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical