Provider Demographics
NPI:1962744995
Name:LUNDQUIST, ANDREA (LICSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 FRONT ST
Mailing Address - Street 2:#3
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-2802
Mailing Address - Country:US
Mailing Address - Phone:978-549-0810
Mailing Address - Fax:
Practice Address - Street 1:384 FRONT ST
Practice Address - Street 2:#3
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-2802
Practice Address - Country:US
Practice Address - Phone:978-549-0810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-16
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1149581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA114958OtherPROFESSIONAL LICENSE - LICSW