Provider Demographics
NPI:1639493323
Name:SIDOLI, ANDREW C (LMSW, LADAC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:C
Last Name:SIDOLI
Suffix:
Gender:M
Credentials:LMSW, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 E MURRAY HOLLADAY RD APT 6
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5314
Mailing Address - Country:US
Mailing Address - Phone:505-504-0260
Mailing Address - Fax:
Practice Address - Street 1:10459 WEST 1300 SOUTH
Practice Address - Street 2:#102
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:801-413-7683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-081081041C0700X
CA1032021041C0700X
UT10084958-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical