Provider Demographics
NPI:1467041947
Name:MERTZ, ANDREW R (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:MERTZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 44TH ST SW STE 120
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2678
Mailing Address - Country:US
Mailing Address - Phone:616-710-1386
Mailing Address - Fax:
Practice Address - Street 1:2845 44TH ST SW STE 120
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2678
Practice Address - Country:US
Practice Address - Phone:616-710-1386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011159291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical