Provider Demographics
NPI:1396280822
Name:EGAN, ANDREW (LICSW)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:EGAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AYLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4714
Mailing Address - Country:US
Mailing Address - Phone:401-312-3377
Mailing Address - Fax:
Practice Address - Street 1:400 AYLSWORTH AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4714
Practice Address - Country:US
Practice Address - Phone:312-316-6121
Practice Address - Fax:312-316-6121
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW018631041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool