Provider Demographics
NPI:1841436201
Name:ANDREA ANDRZEJCZAK PH.D.
Entity type:Organization
Organization Name:ANDREA ANDRZEJCZAK PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ANDRZEJCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-885-8350
Mailing Address - Street 1:20867 MACK AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1392
Mailing Address - Country:US
Mailing Address - Phone:313-885-8350
Mailing Address - Fax:313-885-8357
Practice Address - Street 1:20867 MACK AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1392
Practice Address - Country:US
Practice Address - Phone:313-885-8350
Practice Address - Fax:313-885-8357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009783305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301009783OtherLICENSE NUMBER
1568520559OtherNPI
MI1B 680H230320OtherBLUE CROSS BLUE SHIELD
MI1B 680H230320OtherBLUE CROSS BLUE SHIELD