Provider Demographics
NPI:1467000745
Name:STERN, ANDREW JAY
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAY
Last Name:STERN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66854
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97290-6854
Mailing Address - Country:US
Mailing Address - Phone:541-206-4478
Mailing Address - Fax:
Practice Address - Street 1:2049 NW HOYT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1260
Practice Address - Country:US
Practice Address - Phone:503-321-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor