Active NPI
Andrea Tully
- Social Worker
- Dublin, OH
National Provider Identifier
1033928858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.1450417
- Practice address
- 525 Metro PL N
Dublin, OH 43017-5342 - Phone
- (855) 289-1722
- NPI assigned
- Jan 6, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.1450417 | OH | Primary |
Addresses
Primary practice location
525 Metro PL N
Dublin, OH 43017-5342
Mailing address
6205 Derby PL
Dayton, OH 45424-3888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2910854 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.1450417 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737590400000",
"number": "1033928858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6205 DERBY PL",
"city": "DAYTON",
"state": "OH",
"postal_code": "454243888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 METRO PL N",
"city": "DUBLIN",
"state": "OH",
"postal_code": "430175342",
"telephone_number": "855-289-1722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TULLY",
"first_name": "ANDREA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-01-06",
"last_updated": "2025-01-23",
"certification_date": "2025-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.1450417",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2910854",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dublin, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.