Provider Demographics
NPI:1649423195
Name:MICHAELS, ANDREW (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SADDLE RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2743
Mailing Address - Country:US
Mailing Address - Phone:925-360-9929
Mailing Address - Fax:925-933-8871
Practice Address - Street 1:3184 OLD TUNNEL RD STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4153
Practice Address - Country:US
Practice Address - Phone:925-360-9929
Practice Address - Fax:925-933-8871
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8036103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 8036OtherPSYCHOLOGIST LICENSE