Provider Demographics
NPI:1912212424
Name:KANG, ANDREW DEREK (JD, MSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DEREK
Last Name:KANG
Suffix:
Gender:M
Credentials:JD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FRANKLIN ST # 1
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3507
Mailing Address - Country:US
Mailing Address - Phone:508-740-1091
Mailing Address - Fax:
Practice Address - Street 1:3 FRANKLIN ST # 1
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3507
Practice Address - Country:US
Practice Address - Phone:508-740-1091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health