Andrea Carolyn Bardack, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS 21812 Issued in CA

Practice address

8235 Santa Monica Blvd Ste 400
West Hollywood, CA 90046-5970

Phone

(310) 433-0119

Fax

(310) 278-2560

NPI assigned

Apr 3, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205958261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18316",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902094316",
            "telephone_number": "310-433-0119",
            "fax_number": "310-278-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8235 SANTA MONICA BLVD STE 400",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900465970",
            "telephone_number": "310-433-0119",
            "fax_number": "310-278-2560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARDACK",
        "first_name": "ANDREA",
        "middle_name": "CAROLYN",
        "name_prefix": "Ms.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 21812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Lee Banks
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• Andrea Banty, FNP
• Mark Barats, M.D.
• Denise A Barbuto, M.D.
• Brandy L Barkley
• Barlow Acupuncture Inc.
• Nicholas Jae Barlow, L.AC.
• Galinos Barmparas, M.D.
• Darina Barnes, PHARM D

• All providers in West Hollywood, CA
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.