Provider Demographics
NPI:1386975399
Name:PARK, ANDREW JOHN (MAMHC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOHN
Last Name:PARK
Suffix:
Gender:M
Credentials:MAMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 COUNTY COMPLEX DR
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9505
Mailing Address - Country:US
Mailing Address - Phone:585-396-4190
Mailing Address - Fax:585-383-2916
Practice Address - Street 1:3019 COUNTY COMPLEX DR.
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424
Practice Address - Country:US
Practice Address - Phone:585-396-4190
Practice Address - Fax:585-393-2916
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor