Provider Demographics
NPI:1124681192
Name:DUFRENE, ANDREW TROY (PHD, BCBA)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:TROY
Last Name:DUFRENE
Suffix:
Gender:M
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:TROY
Other - Middle Name:
Other - Last Name:DUFRENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, BCBA
Mailing Address - Street 1:465 CALIFORNIA ST STE 660
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-1845
Mailing Address - Country:US
Mailing Address - Phone:510-592-8776
Mailing Address - Fax:
Practice Address - Street 1:465 CALIFORNIA ST STE 660
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-1845
Practice Address - Country:US
Practice Address - Phone:510-592-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61520805103T00000X
NVLBA0644103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst