Provider Demographics
NPI:1215268024
Name:ANDERSEN, WILLIAM FREDERICK
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3216
Mailing Address - Country:US
Mailing Address - Phone:619-696-9573
Mailing Address - Fax:619-235-2600
Practice Address - Street 1:1568 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3216
Practice Address - Country:US
Practice Address - Phone:619-696-9573
Practice Address - Fax:619-235-2600
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health