Provider Demographics
NPI:1427156926
Name:ANDREWS, DOUGLAS STEVEN (MS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:STEVEN
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4046
Mailing Address - Country:US
Mailing Address - Phone:802-775-6509
Mailing Address - Fax:802-747-0006
Practice Address - Street 1:73 CENTER ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4046
Practice Address - Country:US
Practice Address - Phone:802-775-6509
Practice Address - Fax:802-747-0006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTVT337103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTANDR0626374OtherBCBSVT
VT1001970Medicaid