Provider Demographics
NPI:1689825770
Name:ANDRICK, MICHAEL J (LCPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ANDRICK
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SAM WENTWORTH RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:ME
Mailing Address - Zip Code:04027-3845
Mailing Address - Country:US
Mailing Address - Phone:603-534-5927
Mailing Address - Fax:
Practice Address - Street 1:34 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6446
Practice Address - Country:US
Practice Address - Phone:207-992-2636
Practice Address - Fax:207-947-0435
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433038999Medicaid