Basic Information
| Provider Information | |||||||||
| NPI: | 1790371177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATIAS | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | BAILEY | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11520 WHISPER SOUND DR | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334282404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618704838 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4101 PARKER AVE | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334052507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616161222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2020 | ||||||||
| LastUpdateDate: | 12/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 17350 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.