Provider Demographics
NPI:1740432475
Name:PAPAJOHN, ANDRE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:PAPAJOHN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5614 NORTHWIND CT
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-0241
Mailing Address - Country:US
Mailing Address - Phone:617-230-4073
Mailing Address - Fax:
Practice Address - Street 1:5614 NORTHWIND CT
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-0241
Practice Address - Country:US
Practice Address - Phone:617-230-4073
Practice Address - Fax:614-573-0896
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA890401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical