Provider Demographics
NPI:1427128693
Name:AGEE, ANDREA (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:AGEE
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 1:17 KING STREET
Mailing Address - Street 2:APT 4E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4958
Mailing Address - Country:US
Mailing Address - Phone:212-243-4575
Mailing Address - Fax:
Practice Address - Street 1:17 KING STREET
Practice Address - Street 2:SUITE ONE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4958
Practice Address - Country:US
Practice Address - Phone:212-727-9225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0309141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN20252Medicare ID - Type Unspecified