Provider Demographics
NPI:1649699901
Name:MULFORD, ANDREW (CAC, ICADC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:MULFORD
Suffix:
Gender:M
Credentials:CAC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 PALM COVE BLVD APT 109
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6794
Mailing Address - Country:US
Mailing Address - Phone:973-459-2146
Mailing Address - Fax:
Practice Address - Street 1:1780 PALM COVE BLVD APT 109
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6794
Practice Address - Country:US
Practice Address - Phone:973-459-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL801887OtherICADC (ICRC-ADC)
FLADC-001996-2014OtherCAC