Provider Demographics
NPI:1699302398
Name:PARGULSKI, ANDREW (LSW, MSW)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PARGULSKI
Suffix:
Gender:M
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 LAKE CLUB DR STE 204
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-3198
Mailing Address - Country:US
Mailing Address - Phone:614-604-8573
Mailing Address - Fax:
Practice Address - Street 1:2323 LAKE CLUB DR STE 204
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3198
Practice Address - Country:US
Practice Address - Phone:614-604-8573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.23090661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH010684796Medicaid