Provider Demographics
NPI:1033484225
Name:VANDERPAUWERT, WILLEM (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLEM
Middle Name:
Last Name:VANDERPAUWERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 S WATERMAN AVE
Mailing Address - Street 2:SUITE # 27
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2811
Mailing Address - Country:US
Mailing Address - Phone:951-204-5883
Mailing Address - Fax:909-862-3399
Practice Address - Street 1:1264 S WATERMAN AVE
Practice Address - Street 2:SUITE # 27
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2811
Practice Address - Country:US
Practice Address - Phone:951-204-5883
Practice Address - Fax:909-862-3399
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 213011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical