Basic Information
| Provider Information | |||||||||
| NPI: | 1013551084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDREOZZI | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | DANE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 CHICKEN ST | ||||||||
| Address2: | |||||||||
| City: | WILTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068971809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144241918 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 CROSS RIVER RD | ||||||||
| Address2: | |||||||||
| City: | KATONAH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105363549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147638151 | ||||||||
| FaxNumber: | 9147638947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2019 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 100960 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 100960 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.