Individual
MS. ANDREA LYNN MALTESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
600 N JORDAN AVE, CAPS #448, BLOOMINGTON, IN 47405-3190
(812) 855-5711
Mailing address
1136 W 17TH ST, SUITE B, BLOOMINGTON, IN 47404-3002
(812) 318-1695
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005719A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945018
—
VA
Enumeration date
09/25/2006
Last updated
05/14/2015
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