Provider Demographics
NPI:1023413812
Name:IRRERA, ANDREW JOSEPH (LADC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:IRRERA
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LOIS ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4404
Mailing Address - Country:US
Mailing Address - Phone:203-221-8899
Mailing Address - Fax:203-229-0499
Practice Address - Street 1:1 LOIS ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4404
Practice Address - Country:US
Practice Address - Phone:203-221-8899
Practice Address - Fax:203-229-0499
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001270101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid