Provider Demographics
NPI:1073949608
Name:DIFFENDERFER, ANDREW JOSEPH (BS PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOSEPH
Last Name:DIFFENDERFER
Suffix:
Gender:M
Credentials:BS PSYCHOLOGY
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Mailing Address - Street 1:4300 GOODPASTURE LOOP APT 66
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1417
Mailing Address - Country:US
Mailing Address - Phone:541-844-8771
Mailing Address - Fax:
Practice Address - Street 1:499 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2505
Practice Address - Country:US
Practice Address - Phone:541-686-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-14
Last Update Date:2013-09-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health