Provider Demographics
NPI:1033499934
Name:WAINWRIGHT, ANDREW TAYLOR (CASAC #20543 NYS OAS)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:TAYLOR
Last Name:WAINWRIGHT
Suffix:
Gender:M
Credentials:CASAC #20543 NYS OAS
Other - Prefix:
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Mailing Address - Street 1:SEVEN HOLLAND AVENUE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SEVEN HOLLAND AVENUE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3317
Practice Address - Country:US
Practice Address - Phone:914-683-8050
Practice Address - Fax:914-683-8054
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY20543CASAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01037705Medicaid