Provider Demographics
NPI:1740578327
Name:ANDERSON, ANDREA L (MSAC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:
Credentials:MSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 CORONADO CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-1602
Mailing Address - Country:US
Mailing Address - Phone:805-824-3577
Mailing Address - Fax:
Practice Address - Street 1:3601 CALLE TECATE STE 201
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5290
Practice Address - Country:US
Practice Address - Phone:805-289-0120
Practice Address - Fax:805-289-0130
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2025-04-22
Deactivation Date:2024-12-03
Deactivation Code:
Reactivation Date:2025-01-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073974184Medicaid
CA56CCOtherASPIRA