Provider Demographics
NPI:1629588082
Name:CARRIZO, ANDREA KRISTINA (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KRISTINA
Last Name:CARRIZO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W NORTH TEMPLE APT 345
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1899
Mailing Address - Country:US
Mailing Address - Phone:801-913-1974
Mailing Address - Fax:
Practice Address - Street 1:2225 E MURRAY HOLLADAY RD
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5382
Practice Address - Country:US
Practice Address - Phone:801-913-1974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1041S0200X
UT11803128-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool