Provider Demographics
NPI:1619040383
Name:SHAPIRO, ANDREA R (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:R
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 SIX FORKS RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4465
Mailing Address - Country:US
Mailing Address - Phone:919-781-2020
Mailing Address - Fax:919-783-7029
Practice Address - Street 1:5300 SIX FORKS RD
Practice Address - Street 2:SUITE 205
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4463
Practice Address - Country:US
Practice Address - Phone:919-781-2020
Practice Address - Fax:919-783-7029
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0035121041C0700X
NY0550211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC128EFOtherBCBS