Provider Demographics
NPI:1366900086
Name:SIEMENS, ANDREA M (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:SIEMENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 N KOLB RD STE 121
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4099
Mailing Address - Country:US
Mailing Address - Phone:520-838-0918
Mailing Address - Fax:
Practice Address - Street 1:2055 N KOLB RD STE 121
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4099
Practice Address - Country:US
Practice Address - Phone:520-838-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ175641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ17564OtherLCSW