Provider Demographics
NPI:1144387846
Name:STROMBERG, ANDREW M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:M
Last Name:STROMBERG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WEST 9 ST
Mailing Address - Street 2:APT 7E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8532
Mailing Address - Country:US
Mailing Address - Phone:212-475-1971
Mailing Address - Fax:212-533-9479
Practice Address - Street 1:26 WEST 9 ST
Practice Address - Street 2:APT 7E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8532
Practice Address - Country:US
Practice Address - Phone:212-475-1971
Practice Address - Fax:212-533-9479
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0130801103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02739908Medicaid
NY02739908Medicaid