1841436201 NPI number — ANDREA ANDRZEJCZAK PH.D.

Table of content: (NPI 1841436201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841436201 NPI number — ANDREA ANDRZEJCZAK PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDREA ANDRZEJCZAK PH.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841436201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20867 MACK AVE
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
GROSSE POINTE WOODS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-1392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-885-8350
Provider Business Mailing Address Fax Number:
313-885-8357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20867 MACK AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
GROSSE POINTE WOODS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48236-1392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-885-8350
Provider Business Practice Location Address Fax Number:
313-885-8357
Provider Enumeration Date:
01/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANDRZEJCZAK
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
313-885-8350

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  6301009783 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6301009783 . This is a "LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1568520559 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1B 680H230320 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".