Provider Demographics
NPI:1992804850
Name:ANDRADE, GLORIA A (LCSW)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:A
Last Name:ANDRADE
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 1:679 GRANT TER
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6522
Mailing Address - Country:US
Mailing Address - Phone:201-287-1910
Mailing Address - Fax:
Practice Address - Street 1:175 CEDAR LN STE 3
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4315
Practice Address - Country:US
Practice Address - Phone:201-310-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045586001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0059927Medicaid